Health Foundation Reports on Conditions in Puerto Rico 6 Months After Hurricane Maria

Earlier this month, a team from the Henry J. Kaiser Family Health Foundation traveled to Puerto Rico as well as the US Virgin Islands to assess the recovery of the healthcare system 6 months following Hurricane Maria.

What they found, after interviewing more than 30 residents, business owners, healthcare providers, and territory officials, as well as phone interviews with federal officials and other organizations, is a very mixed situation, with some areas faring better than others, but with much more work remaining before the islands can restore to a state of normalcy.

Compounding the problem, the next hurricane season is approaching while the area has not yet recovered from the first one.

“Healthcare is really the foundation for the sustained economic recovery on the islands,” said Barbara Lyons, senior vice president, Henry J. Kaiser Family Foundation.

She said everything else—tourism, job creation, and other factors—all hinges on having a reliable healthcare system in place. It will require investment, particularly in the form of Medicaid dollars, she said.

Samantha Artiga, the foundation’s disparities policy project director, said overall, progress has continued, but issues delivering healthcare on Puerto Rico and the US Virgin Islands remain:

• There are increased physical and mental health needs, including increased reports of depression, anxiety, and posttraumatic stress disorder (PTSD). At the same time, access to mental health care is limited due to provider shortages that existed even before the storm.
• Healthcare providers and staff continue to work extreme hours amid their own ongoing personal challenges.
• People are leaving the islands, particularly young professionals and health professionals.
• Lives remain disrupted, with many still displaced from their homes, facing job losses or changes, and financial instability.
• There are continued power and communication problems.
• The next hurricane season is rapidly approaching, leaving organizations and individuals limited time to prepare.
• While there has been some economic recovery, revenues and tourism are still down. Major hotels on the US Virgin Islands remain closed.
• Job losses are causing patients to lose private health coverage.
• Specialists are leaving the islands, and it is becoming challenging to retain and attract other providers and nurses.

In Puerto Rico:

• Hospitals have resumed operations. While clinics are operational, some are still on generators.
• The most severe access issues remain in mountainous and offshore island areas.

Rafael Rodríguez-Mercado, MD, secretary of health for Puerto Rico, compared Hurricane Maria to going to bed on September 19, 2017, and “waking up in 1955” the next day. He credited nonprofits and nongovernmental organizations for preventing a more severe health crisis in remote areas.

In the US Virgin Islands:

• The 1 hospital has major structural damage and is waiting for a FEMA assessment and is operating at limited capacity.
• High-need patients must be transferred off the island.
• The island lost a quarter of staff, including many nurses.
• Clinics have resumed operations.

In addition to the physical damage, Puerto Rico has major fiscal challenges.

Artiga said federal relief funding for Medicaid provides key support, but that relief funding does not address long-term underlying fiscal problems or disparity in federal match and cap on federal funds. In 2019 that relief funding will end, causing major issues.

Puerto Rico faces the added challenge of implementing major delivery system reform and achieving savings specified by the Fiscal Oversight Board. The US Virgin Islands is also engaged in broader delivery system reform efforts, she said.

The board is demanding that Puerto Rico save $100 million a year for each of the next 5 years. Rodríguez-Mercado said Puerto Rico may reach a point where “we may save money but we are not going to have health providers to offer services to the people of Puerto Rico."