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Outbreak: The Advent of the Health Services System Malaise Published: Sunday, September 11, 2005 By: Dr. Manuel Ángel Morales

In our last column we discussed the current situation ofPuerto Rico’s economy and defined it as stagflation. Now we discuss an emerging challenge to the health industry economic infrastructure and its possible implications forPuerto Rico’s social fabric. This challenge is hidden within the changes being experimented in the distribution of our demographic spectrum, and it is called by demographers “the ageing population effect”.

In the 2000 censusPuerto Ricohad just 8% growth in terms of population increase when compared to 1990. That means that the yearly growth rate was below 1%. By the seventies yearly growth was 1.7%, by the eighties it was 1 percent and by the nineties well below 1%. This means that for the last thirty (30) yearsPuerto Rico’s growth rate has been shrinking, and its population has started a process of ageing, that is less people are being born, living people are becoming older.

Our research foresees that this trend will be irreversible, if current birth and mortality rates maintain their behaviors. By 2010 population growth will be of 4.8%, by 2020 it shall be close to 3% and by 2030 there shall be no growth. From then on the population will begin to shrink by -2.6% on 2040 and -4.8% by 2050.

This information is crucial because, the groups that consume the bulk of health services are those below five (5) years of age and those beyond fifty-nine (59) years of age. When taking this into account we can establish that there will be emerging and increasing a need for accessing health services for the next twenty-five (25) years.

So if we correlate an inflation running wild, the population becoming old and we take into account that the current health infrastructure is taxed beyond endurance; it is fair to conclude that there is a looming crisis, in terms of availability of services and of the capacity for financing those services.

For this reason, we have prepared an estimate ofPuerto Rico’s health expenditure per capita scenario, just to provide an empirical perspective on this challenge. In the next table you will find information regarding the population distribution, the overall per capita out of pocket expense, per capita doctor’s office expenditures, per capita hospital expenditures and per capita rest of health services-products expenditures.

If the current health infrastructure is not reinforced, the possibility of people being unable to access health services and medicines is highly probable. We estimate that close to 55% percent of the population beyond fifty-nine (59) years of age would be unable to access these services for 2010. The result of people being unable to satisfy their health services needs would induce high anxiety, social unrest and would pressure the public health system to its breaking point.

Therefore, public policy must be focused on:

  • Establishing Financial Contingencies – Government must deal decisively with the current budget imbalance, reduce public debt, create a health services mega-trust fund and invest in the current health infrastructure.
  • Promoting a Wellness Lifestyle – Implement in all educational institutions, courses on health, eating habits and physical efficiency. Some sort of tax credit could be created for those individuals who attain a low utilization rate in their medical coverage.
  • Maintaining “Seasoned” Citizens in the Workforce - It is important to rethink the terms of retirement for individuals. There are some psychological aspects that must be taken into consideration, and that have health implications when managed improperly. Research has demonstrated that when people maintain some level of productivity their propensity for developing health complications diminishes.

This challenge demands the creation of bold, radical and innovative ideas. We need to tap into the different sectors of our society to dispose of the best intelligence to tackle this dilemma. If not, then a possible future scenario would be a social reality in which hardworking, committed and productive individuals, will be deprived of living their final days with dignity, respect and with the society’s gratitude for their sacrifice.

We must not let this happen. It is our responsibility, our mission and our moral task to nurture those who gave us a good opportunity to live, grow and flourish.

God bless you all.


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