P.R. Laws tit. 24, § 7001
As part of a radical reform of the health services in Puerto Rico, this chapter is established to create the Puerto Rico Health Insurance Administration. It is a public corporation with full authority to develop the functions entrusted by this chapter.
The Administration shall have the responsibility to implement, administer, and negotiate a health insurance system by means of contracts with insurers and/or Health Services Organizations, as such term is defined in §§ 1901 et seq. of Title 26, known as the “Health Services Organizations Act”, incorporated into the Insurance Code of Puerto Rico, which shall eventually give all the residents of the Island access to quality medical and hospital care, regardless of the financial condition and ability to pay of those who require them.
From the turn of this century, the public health policy of Puerto Rico has revolved around the viewpoint that the government has the responsibility of rendering direct health services.
Pursuant to policy, two health systems have evolved which are notably unequal. In general terms, we can affirm that the quality of health care in Puerto Rico has come to depend predominantly on the financial capacity of the person to cover the cost thereof with his/her own resources.
Within this scheme, the care of the medically-indigent sector of our population has fallen upon the Department of Health. The good intentions of its officials have not been sufficient to counteract the adverse effects on the quality of the Department, factors such as: budget insufficiency; rising cost of technology and medical supplies; bureaucratic growth and, centralism; and the interference of party politics with departmental efforts.
Since 1967, there have been several attempts in Puerto Rico to reform the medical and hospital services of the Department. However it has not been possible to narrow the ever-widening gap between the quality of public and private services.
This experience provides the background of the public policy set forth by this chapter. The public policy is the following: The Administration shall approach, negotiate and contract health services insurance companies and providers to provide quality medical and hospital services, particularly to those who are medically-indigent.
The Administration also shall establish control mechanisms addressed to prevent an unjustified rise in the costs of health services and insurance premiums.
History —Sept. 7, 1993, No. 72, Art. II; July 19, 2002, No. 105, § 1; Aug. 8, 2010, No. 123, § 1.