Puerto Rico's Federally Funded Community Health Centers in Crisis

Nearly 1 in 10 people in Puerto Rico depends on community health centers for their care compared with 1 in 14 in the mainland United States. However, that care is at risk for Puerto Ricans, according to a new report by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative, based at the Milken Institute School of Public Health at the George Washington University.

With more than 75% of those served by Puerto Rico’s health centers covered by Medicare, Medicaid, or both, and reimbursement rates in Puerto Rico far lower than stateside, there is a deficient level of funding for the community health centers. Despite considerable growth in Medicaid as a result of funding provided by the Affordable Care Act, 12.2% of health center patients remain uninsured.

The report, “Puerto Rico’s Community Health Centers in a Time of Crisis” shows both the extent of the health centers’ role in Puerto Rico’s healthcare system and the challenges they face serving a population with high needs at a time of rising health system crisis, said Sara Rosenbaum, JD, Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute School of Public Health and an author of the report.

Puerto Rico has faced significant economic and fiscal challenges—poverty and high unemployment are entrenched. Nearly 1 in 2 residents of Puerto Rico lived below the poverty line in 2013, and the island’s aging population will increasingly need to rely on public programs. The government faces a $72 billion debt crisis and has instituted severe austerity plans that have triggered a spike in unemployment and deepening poverty.

Despite the funding challenges, the health centers were found to perform well on a majority of quality measures. In addition, their average per-patient costs are also lower than those of health centers outside Puerto Rico despite their greater reliance on physician-provided care.

“Community health centers are a critical component of the health care safety net but they can’t do it alone,” said report coauthor Peter Shin, PhD, MPH, Director of the Geiger Gibson RCHN Community Health Foundation Research Collaborative.

The ongoing ability of Puerto Rico’s health centers to meet the growing need among higher-risk populations depends strongly on the extent to which the structural shortcomings of Medicare and Medicaid financing are addressed, the report concludes.