Even though medical tourism is among the proposals in the Plan for Puerto Rico, and the Governor mentioned it in his recent state address, the person who will lead this effort has yet to be appointed. There is no news either about the guidelines that will be followed to attempt to strengthen this niche, which will have to look for ways to compensate for the medical “brain drain” and the lack of specialists in certain areas.
In spite of previous initiatives, it was not until 2010 that the Puerto Rico Medical Tourism Act was created, with the purpose of promoting the development of this industry. Four years later, the Puerto Rico Medical Tourism Corporation was founded as a subsidiary of the Tourism Company, with the purpose of establishing public policy and gaining ground in this field.
In April of 2015, the Pavía Hospital in Santurce became the first healthcare provider in the Island to obtain the medical tourism certification, granted by both the Medical Tourism Corporation and the Medical Tourism Association, which is headquartered in Florida.
Early last June, the Corporation announced the opening of a Star Concierge Hub, a new center for patient management and care.
When Francisco Bonet submitted his resignation as the Corporation’s executive director last October, the situation was the following: only 64 certified providers, including outpatient clinics, hospitals, hotels, transporters, specialists, and excursionists.
A $3.8-million investment boosted publicity and marketing efforts, as well as the creation of the Star Health Puerto Rico medical tourism brand, and the inauguration of a web page with information about certified services and providers in the Island. By then, 330 applications from abroad had been addressed, with dental services (45%) being the most requested, followed by cosmetic procedures (31%), bariatric treatments (11%), orthopedic services (4%), cardiology (3%), and cancer treatments (2%). The lower costs, compared to the United States, seem to be one of the appeals of this local market. For example, the cost of a knee replacement in the US is about $34,000, while in Puerto Rico it is estimated at $24,000.
Destination: Puerto Rico
One of Rosselló’s proposals, named “Destination: Puerto Rico”, intends to create tourism clusters, including medical tourism in collaboration with healthcare providers and insurance companies.
“We want our Island to become an important regional center for specialized health services. We are going to develop Puerto Rico as an appealing medical tourism destination, and—as part of multiple initiatives—make it easier for high-quality medical specialists to settle here in our Island,” Rosselló said last Tuesday in his public address.
El Nuevo Día tried to learn more about the Government’s efforts regarding this measure. The Tourism Company referred our questions to the Department of Economic Development and Commerce (DDEC, by its Spanish acronym), which did not address our request for three consecutive days.
Meanwhile, data from the College of Physicians-Surgeons of Puerto Rico—which was last updated on February 9—reflects the dramatic drop in medical specialists in certain areas, like head and neck surgery (5), hand surgery (5), colon and rectum surgery (5), pediatric nephrology (2), and musculoskeletal oncology (1).
Area of Opportunity
“The truth is that (medical tourism) has not taken off as it should,” remarked Dr. Víctor Ramos, president of the College of Physicians-Surgeons of Puerto Rico.
Although he acknowledged that this is an area “with a lot of potential, if it’s done right,” he admitted that the road is difficult, considering the medical drain and the shortage of certain specialists.
He reiterated that some issues should be addressed so as to support providers who wish to serve medical tourism patients. Among these issues, he mentioned insurance for medical malpractice, because if complications arise with these patients, the cases would be addressed at a federal level.
He added that for certain areas, such as ophthalmology, plastic surgery, back surgery, and certain dental specialists, dedicating their practice to medical tourism could be very appealing, due to the possibility of having greater income stability. This possibility, he said, could help keep doctors in the Island.
“We have to initiate conversations with other governments,” noted attorney Marta Rivera, president of the Hospital Association’s Board of Directors.
She agreed that it’s of utmost importance for the Government to help in promoting and emphasizing that healthcare services in the Island may be more cost-effective. She added that alliances should be established with US health insurance companies to attract new patients.
Domingo Cruz, executive director of San Jorge Children’s Hospital, concurred that medical tourism—an area that has been in development over the past three years, especially in islands close to Puerto Rico—could help retain doctors and mitigate the effects of patient migration. He highlighted that the population of patients aged 0 to 5 in the Island has decreased by 40%.
“Maybe it wasn’t as necessary for the economy as it is now,” he said.
In the case of San Jorge Children’s Hospital, he pointed out that they receive 60 to 70 medical tourism patients per month, for visits to medical offices, lab tests, hospitalizations, or medical tests. In the case of outpatient services, he mentioned that these families usually take advantage of their stay in the Island to visit stores or restaurants, which contributes to Puerto Rico’s economy.
Madeliza Ramírez from Metro Pavía Health System mentioned that this company has been promoting different medical tourism initiatives for over 25 years. She said that 40% of the patients they serve in this area do not have healthcare coverage and pay out of pocket. Even though at a governmental level the Corporation is “stuck” after Bonet’s resignation, she pointed out that private initiatives like the ones from Metro Pavía continue their course, such as those maintained in satellite offices in Saint Thomas, Santa Cruz, and Tortola, among others.
Margarita Rodríguez from HIMA Health asserted that this hospital system is also betting on medical tourism in the nearby islands. Neurology, oncology, pediatrics, rheumatology, cardiology, orthopedics, and obstetrics were some of the areas mentioned as being in greater demand, although she reiterated that many patients arrive in “very compromised” health conditions, and require multiple medical specialists.
“We already have the structure, but the Corporation’s help is always welcome,” she upheld.