Health sector reform: the case of Puerto Rico

Abstract

[Introduction]. Responding to a request by the health authorities of Puerto Rico, a working party made up of staff from the different divisions of the Pan American Health Organization (PAHO) met over a three-day period with more than 100 people representing the Department of Health, the Health Insurance Administration, a variety of public institutions, and private insurance carriers to analyze the progress made in health reform and to identify and come to an agreement on areas suitable for PAHO technical cooperation to further this reform. The work accomplished during this meeting facilitated coordination among the divisions and programs at PAHO Headquarters and brought the participants up to date on the health sector reform that had been proposed and implemented—a reform program with characteristics very different from those of other efforts under way in the Region. In particular, the work made it possible to provide an appropriate response to a specific request by one of the Member Governments of the Pan American Health Organization. The report begins with a series of issues and general reflections on the transformation of States and health systems, and an attempt is made to describe the context of the key areas of the Puerto Rican reforms, followed by a discussion of the differences in their implementation and administration. The background of the reform process and its current status are analyzed, and the report concludes with some specific recommendations that could be utilized to guide eventual changes. The Division of Health Systems and Services Development and the Program on Organization and Management of Health Systems based on Primary Health Care presents this publication as a contribution to the discussion of the reform processes in the Region.