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The Dominican Republic shares the Caribbean island of Hispaniola with Haiti. The island was reached by explorer Christopher Columbus on his first trip to the New World from Europe in 1492, and was inhabited by indigenous Tainos before the arrival of Spanish colonists. Traditionally a sugar producer, the economy of the Dominican Republic is currently dominated by the service sector of the service industry, and the country is now the largest tourist destination in the Caribbean.

As a middle income country, the Dominican Republic has per capita GDP of over USD5, 000. Local inhabitants have a strong passion for music and sports; merengue dancing and baseball are both extremely popular. According to UN health agency the World Health Organization (WHO), life expectancy in the Dominican Republic is 66 years for males and 74 for females. These figures are below the regional average for the Americas. Demographic concerns in the Dominican Republic include problems associated with migrants from neighboring Haiti.

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Overall health expenditure per capita in the Dominican Republic is USD449, which is only a small fraction of the WHO Americas regional average, and represents 6. 0 percent of GDP. Approximately 41. 4 percent of total health spending comes from government expenditure. Private Dominican Republic health insurance represents about 22. 5 percent of overall private health spending, with the remainder coming from out of pocket expenditure. Communicable diseases are prevalent above the regional average in the Dominican Republic, with 11 cases of HIV per 1,000 adults and 95 cases of tuberculosis per 100,000 people.

However, thanks to improvements in health care, figures show that an increasing number of childbirths in the Dominican Republic are attended by skilled health care professionals, and as a result of improved postnatal care, children aged less than five years old with stunted growth and early mortality have both steadily decreased over the past twenty years. However, Dominican hospitals and health centers are relatively understaffed, with a shortage of nurses and midwives. ‘Brain drain’ is a serious concern as many skilled health professionals seek more lucrative opportunities in NorthAmerica.

The Dominican Ministry of Social Health and Public Welfare (SESPAS in Spanish) cooperates with the WHO in implementing health policies in line with the UN’s Millennium Development Goals for 2015. These include providing universal primary health care, improving environment, water and sanitation conditions, attract a greater number of skilled health professionals, and improve programs in the prevention and control of communicable and vaccine-preventable diseases. No serious disease outbreaks have been reported by the WHO Global Alert and Response team recently within the Dominican Republic.

However, a recent outbreak of cholera attributed to Haitian migrants and refugees has been contained, and the Pan American Health Organization (PAHO) has reported an increase in H1N1 flu outbreaks. There have also been reported outbreaks of the waterborne disease leptospirosis. The vast majority of your medical needs can be met on the island. However, interventions requiring high-tech equipment or a long period of rehabilitation may not be available. It is recommended that you obtain medical insurance as a first priority. Particularly advantageous is a dual policy which covers medical expenses abroad.

While investigating different insurance policies, note that in the DR there are very few GPs or family doctors; the vast majority of physicians consider themselves specialists. Therefore, you should choose a pediatrician for your children and an internist for yourself. These doctors will serve as the equivalent of GPs, and they should be able to refer you to other specialists if necessary. The state healthcare system is free but far from adequate, although it does meet some needs, such as the provision of vaccinations and infant rehydration supplies.

Facilities, trained staff and medicines are often lacking. Patients may be asked to pay for materials and for their prescriptions, putting the costs beyond their financial possibilities. The Social Security system is also far from adequate. Nevertheless, certain Social Security clinics offer good services, and even people who have alternative medical insurance may choose to take advantage of benefits such as the provision of free milk. Private clinics are also an option in the DR. Fees, however, range from RD$400 to RD$3,000 for a first visit, depending on the clinic and the specialist.

Many employers provide insurance called an “iguala,” which can also be purchased on an individual basis. Monthly payments are made to a certain clinic, which agrees to provide all the medical services that you need at no additional cost. Certain limitations may apply. For instance, it may be possible that a certain type of specialist is not available at your particular clinic and you have to go elsewhere, and you will in effect have no cover under the scheme. True medical insurance plans come in various types.

One type will reimburse your medical expenses, possibly including your medications. This type of plan provides broad coverage, but you need to have the cash to pay your bills at the time services are provided. A second type of insurance pays a certain portion of each bill. For example, you might be responsible for RD$50-RD$100 of any doctor’s fee of RD$600. This type of plan often has a restricted list of physicians or clinics, and the list will change from time to time. Foreign insurance companies based here (primarily from the US) offer insurance which includes coverage abroad.

The best idea is to purchase a policy with a very high deductible (excess) for overseas care to reduce the cost, as this is essentially only for major disasters. Many medical insurance policies are available to individuals for virtually the same price as they are offered through employers. The prices of these policies will depend on the age of the applicant, and the company he/she is applying to. The monthly costs can vary, though an individual, however, might have to pay for six months to a year in advance rather than benefiting from a monthly payment schedule.

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