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Healthcare, Funding, Power Woes Still Plague Puerto Rico One Year After Maria

Allison Inserro
A new issue brief from the Henry J. Kaiser Family Foundation reports on healthcare and recovery efforts 1 year after Hurricane Maria struck Puerto Rico and the US Virgin Islands (USVI), with residents still struggling to regain what they lost, a lack of capacity due to damaged facilities or lack of staff, and financing woes that will make moving forward difficult if they are not addressed.
 
A new issue brief from the Henry J. Kaiser Family Foundation reports on healthcare and recovery efforts 1 year after Hurricane Maria struck Puerto Rico and the US Virgin Islands (USVI), with residents still struggling to regain what they lost, a lack of capacity due to damaged facilities or lack of staff, and financing woes that will make moving forward difficult if they are not addressed.

Although Puerto Rico’s initial death toll was 64, researchers estimated in various reports that the number was far higher as residents died from lack of power to fuel medical equipment, lack of medicine or emergency care in the storm’s aftermath, and other probable factors. A recently released study commissioned by the governor of the island found total excess mortality of 2975 deaths in the 6 months after Hurricane Maria and revised its official death toll, although it called the number an estimate. Here is a look at some of the hurricane-related problems still facing the US territories 1 year after Hurricane Maria:

Healthcare and vulnerable populations
Healthcare providers are still seeing increased needs related to chronic conditions and medication adherence, particularly for diabetes. Access to dialysis treatment in USVI and on Vieques in Puerto Rico remains limited.

The elderly, people with disabilities, and other special needs populations remain the most vulnerable and need the most help obtaining medical services. Among Puerto Rico residents who have a debilitating chronic condition or disability or have a household member who does, 41% of those surveyed in a recent Washington Post/Kaiser Family Foundation (WaPo/KFF) survey said that a health condition had appeared or worsened because of Hurricane Maria.

In addition, vulnerable populations have been affected by outward migration, as relatives or other caregivers have left for the mainland. A draft Puerto Rican government report estimated that outmigration tied to Hurricanes Irma and Maria in the 2 years after the storms could match the 14% population loss from 2006 to 2016, although the final recovery plan removes this estimate.  

The number of domestic air passengers leaving—another signal of outmigration trends—was roughly 125,000 people higher than expected in the 12 months ending in March 2018.

Provider gaps
In both territories, the hurricanes have worsened infrastructure limitations and an inability to offer competitive salaries, which have been longstanding barriers to recruiting and retaining staff. There are staff shortages in certain subspecialties or geographic areas, and patients must sometimes wait up to 9 months for specialist appointments following referrals.

Puerto Rico’s government has offered tax incentives and other strategies to try to fill gaps, but provider reimbursement rates in the continental United States are higher than those in the territories. Some community health clinics reported a 3% to 5% increase in patients due to the loss of private providers.



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