Puerto Rico's community health centers face bleak future, experts say

A higher proportion of Puerto Rico's population -- nearly 1 person in 10 -- depends on community health centers for their care, as compared with 1 in 14 on the mainland. Yet with more than 75 percent of those served by Puerto Rico's health centers covered by Medicare, Medicaid, or both, reimbursement rates far lower than stateside, no tax subsidies for private coverage, and 12 percent remaining uninsured, that care is at risk.

The report, produced by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative, which is based at Milken Institute School of Public Health (Milken Institute SPH) at The George Washington University, uses national and Puerto Rico data sources, supplemented by information from a focus group of Puerto Rico health center leaders, to assess the opportunities and challenges of providing care during this economic crisis.

"The findings show both the extent of health centers' role in Puerto Rico's health care system and the challenges they face serving a high-need population at a time of an escalating health system crisis," said Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute SPH and one author of the report.

The report examines the economic and funding conditions under which Puerto Rico's community health centers are operating. In addition to a $72 billion debt crisis, Puerto Rico's unemployment exceeds 12 percent, far higher than the U.S. average. A series of Medicare and Medicaid policies exclusive to Puerto Rico leads to less coverage and lower reimbursements, while a mass exodus from the island of 4,000 health professionals, including cardiologists, anesthesiologists, as well as primary care physicians, has deepened the crisis.

"More than three quarters of the patients served by Puerto Rico's 20 health centers, which operate more than 70 clinic sites throughout the island, are covered through public health benefits such as Medicare and Medicaid, but the lower reimbursement rates leave community health centers with a deficient level of funding," said Feygele Jacobs, President and CEO of the RCHN Community Health Foundation.

Despite the funding challenges, the report also finds that Puerto Rico health centers perform well on a majority of quality measures. Their average per-patient costs are also lower than those of health centers outside Puerto Rico despite their greater reliance on physician-provided care.

"Puerto Rico's health care safety net infrastructure is deteriorating," adds Peter Shin, PhD, MPH, Director of the Geiger Gibson RCHN Community Health Foundation Research Collaborative and co-author of the report. "Community health centers are a critical component of the health care safety net but they can't do it alone."

The report, "Puerto Rico's Community Health Centers in a Time of Crisis" was funded by the RCHN Community Health Foundation.