According to the article “artículo “Avalan incentivos contributivo para médicos del país” by Rebecca Banuchi, published on the newspaper El Nuevo Día on February 8, 2017, Bill 5 was passed. Through this bill there will be a significate reduction on the taxes of doctors in Puerto Rico with the end game of reducing the number of doctors that are leaving the country and to increase the return of them to the country. According to the article, if the taxpayers identified as doctors in Puerto Rico accept the benefits of this bill, it is estimated that the treasury will have impact of $185 million dollars.

The bill proposes that the fixed tax rate for doctors be 4% and it would have a term of 15 years. The Secretary of the “Departamento de Hacienda”, Raúl Maldonado Gaudier, stated that it is costly for the government that doctors are leaving Puerto Rico, since they do not pay taxes. The President of the JSF, José Carrión III, stated that the government must certify the fiscal impact that recent legislation has. The President of the Healthcare Commission, Juan Oscar Morales, stated that the bill will not have problems with the entities that control the government’s finances.

The bill identifies as “qualified doctors” general doctors, specialized doctors, podiatrists, dentists, dental surgeons and specialized dentists. Also, the bill includes a list of guidelines to follow when evaluating doctors’ requests to benefit from the bill.

The bill has been criticized under the argument that it will take a toll on the public treasury, it does not attend other problems that cause doctors to leave such as problems with insurance companies, and it did not take into account the “Comisión de Hacienda’s” analysis regarding the fiscal impact that the bill will have.

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According to the article “Medicare patients death shortly after leaving the ER raises questions about rural hospitals” by Casey Ross, published on the StatNews website on February 1, 2017, questions regarding staff and treatment of patients in rural hospital have been raised after a study brought to light the deaths of patients beneficiaries of Medicare after being discharged. According to the study, more than 10,000 Medicare patients, who do not have life-threatening conditions, die annually around 7 days after being discharged from hospitals.


The study has also risen questions regarding rural hospitals’ adequate resources and if the Government’s intent on lowering costs has had an impact on basic and essential care. It is no secret that under the Affordable Care Act hospitals have to treat patients efficiently while having to reduce admissions which are considered unnecessary. This in turn has resulted in the discharge of patients and exploring outpatient treatment as an option. According to Dr. Rade Vukmir, fellow of the American College of Emergency Physicians, has stated that Medicare and private insurers’ strategies regarding admissions and discharge have had an impact on decision-making.

According to the article the study shows that there is a higher rate of unpredicted deaths in low admission hospitals than in high admission hospitals. Dr. Zaid Obermeyer, an emergency medicine physician and professor at Harvard Medical School, states that   “it doesn’t seem that the deaths are due to random chance. There is something different going on in those low-admission-rate hospitals.” Obermeyer also stated that there are several factors that may cause this problem, such as limited staffs, fewer transportation, problems with hospital protocols, and not necessarily can providers be attributed the cause.

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According to the article “Harvard doctors just revealed how many people will die from repealing Obamacare” by Zach Cartwright, published on on January 23, 2017, the repealing of the Obamacare is “fatal”. Doctor David Himmelstein and Doctor Steffie Woolhandler, professors of public health at the City University of New York’s Hunter College and lecturers in medicine at Harvard Medical School, agree “that even under the most conservative estimates, getting rid of President Obama’s signature healthcare reform law will result in 43,956 deaths every year”.

Both doctors used the findings of the New England Journal of Medicine (NWJM) “that for every 455 people across multiple states who received health insurance through Medicaid expansion, at least one life was saveddue to finally being able to see a doctor” in order to reach their number of 43,956 deaths every year. President Trump, House Speaker Paul Ryan and Representative Tom Price have come up with a replacement reform of the Obamacare. Both doctors also argued that the reforms presented to replace the Obamacare “could actually cause even more deaths than they initially predicted”.

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According to the article “seguradoras responsabilizan a  los médicos de sus pérdidas” by Marga Parés Arroyo, published on the newspaper El Nuevo Día on January 25, 2017,  insurance companies allege that doctors are the cause of their losses.

Two insurance companies have emitted guidelines which affect the Medicare Advantage Program. According to the article, Triple-S sent a doctors a letter on December in which they were informed of the amendments in their contracts in order for to make them take responsibility for the mismatch of funds that companies has annually, starting on January 9, 2017. Víctor Ramos, President of the College of Doctors, stated that due to the amendments in the contracts of physicians with Triple-S, they would be paying up to 25% of the deficit that the insurance company incurs due to a mathematical or actual error. The amendments allow Triple-S to billed doctors for any deficit up to 16 months after the end of the year. Ramos, also indicated that the doctors who rejected the amendments, received a second letter from Triple-S where they were requested to reconsider their position, something Ramos has interpreted as the possibility that their contracts with the insurance company be cancelled.

The article also indicates that Triple-S and MCS have decided not to comply with some increases in the Medicare Advantage Program for 2018 according to the Geographic Pricing Cost Index, a calculation through which Medicare and Medicaid repay doctors. According to Ramos, Triple-S and MCS have indicated that they will be amending the list of prices of Medicare to those of 2016 in order to not pay the increase in payment doctors will be receiving for the procedures done in 2018.

Ramos stated that this situation will make the number of doctors fleeing from Puerto Rico to increase. Carlos Mellado, ex Advocate of the Patient, stated that everything that affects the practice of medicine will have an increase in the exodus of doctors from Puerto Rico and that insurance companies need to be regulated.

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According to the article “Inminente crisis de salud” by Yaritza Rivera Clemente, published by the newspaper El Nuevo Día on January 19, 2017, during 2009 and 2014 there’s been a reduction of doctors in Puerto Rico of 13,452 to 11,088. Said numbers supports Rafael Rodríguez Mercado’s, Secretary of the Department of Health, statement that there is a lack of general and trauma surgeons, endocrinologists and neurosurgeons. Rodríguez also indicated that the patients of the Reform have been affected with the departure of so many specialists since these are affiliated with the Reform and these patients have been forced to seek treatment at Centro Médico, which in turn has caused that this hospital be visited by a large number of people. During the Public Hearing of the “Proyecto de la Cámara 5” which promulgates the “Ley de Incentivos para la Retención de Profesionales Médicos”, Rodríguez stated that Centro Médico has been receiving patients from Mayaguez and Vieques, which in turn has cause a $494 million dollars deficit. Said project proposes a reduction of the fixed tax rate of 4% of the generated income to doctors who provide services to “Mi Salud” plan or comply with the annual 180 hours of community service.  

Meanwhile, Concepción Quiñones de Longo, subsecretary of the Department of Health, stated that there has been a reduction of 8,452 to 6,713 of specialized doctors. Victor Ramos, President of the College of Surgeons, indicated that there is a lack of specialized doctors in the pediatric area, since there are only 2 pediatric neurosurgeons, 3 radiologists and 2 pediatric vascular surgeons.

There isn’t only a problem with the departure of specialized doctors from the country, but doctors have also been affected by insurance companies. That’s why the Health Commission of the House of Representatives will be reviewing and regulating the services provided by insurance companies. Ángela Ávila Marrero, acting executive of the “Administradora de Seguros de Salud” (ASES), stated that insurance companies are the ones who contract the doctors and not the Government and that the actual model that is implemented is one “of coordinated care with the complete risk of the insurance company”.  

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