Advocating For the Expansion of the Social Security Program in the Dominican Republic
Estimation Year
1996
Actual Policy Use
Informed the debate and discussion on social security reform. The 1996 NHA estimates revealed large out-of-pocket expenditure amounts, especially in comparison to government funding. Also, the 1996 report (Salud y Equidad, by Magdalena Rathe, sponsored by USAID through Macro International and PHR) included a detailed equity analysis that showed the significant financial burden of health care on households. These findings were used as a justification for expansion of the social security program.
The health sector reform process began in the early 90s due to an increased perception that the health sector was not working. There was a need then to better understand financial aspects of the health sector. The equity analysis of the 1996 NHA was instrumental in providing critical input to discussions and legislation, thereby demonstrating a critical link between NHA data and existing laws.
The new Social Security law that mandates institutional reform of the health sector was enacted in May 2001 and went into effect in November 2002. That law stipulates 3 contributions regimes to the social security fund, depending on the socioeconomic status of the insured: 1) contributions are shared between the employee and employer; 2) contributions are made by informal workers based on their income level, with a supplement from the central government; and 3) contribution is paid in full by the government (i.e. total subsidy for the poor or chronically disabled).
Social security funds are managed by the government. A managed competition model is used to allocate funds to insurance brokers / risk managers that contract with public and / or private providers to deliver services based on demand and with built in subsidies that incentivize demand for primary care. The social security law also mandates the separation of functions: within a 10 year grace period, MoH will cease to be a provider and financier of health service to concentrate on its stewardship role.
MoH facilities will remain public but will be controlled by local institutions as a result of a decentralization process (similar to community hospital in the US with a board of directors and a network of primary care providers).
Source
Magdalena Rathe, Former NHA team member
