Backstage

Over a year ago, based on the history of Puerto Rico's Health Reform that started on 1993, many people started to wonder if the enrollees of this system were healthier or sicker than years ago, when they had no medical coverage. To find out, a key point was to measure if they were getting the medical preventive services they needed to, for example, have an earlier diagnosis and a better treatment for the medical conditions they may develop.

That was what my National Health Journalism Fellowship was about and what I intended to find out. 

Based on this preoccupation, the information gathering started. The period we decided to investigate was the first year of Mi Salud (the fifth version of Puerto Rico's Health Reform), which was between October 2010 and September 2011. During the way of our investigation, we had several barriers, mainly, in accessing documents that could tell us what medical services the enrollees were getting.

While we waited for several information and interviews requests with the government (Department of Health and Health Insurance Administration) and the health insurance companies hired to administer Mi Salud (MCS and Humana), we interviewed several providers. The consensus was that the offering of preventive services needed to be of critical importance to all the providers, as well as the government and the 1.5 million of enrollees under the coverage of Mi Salud. Many believed that the enrollees don't have the access to preventive medicine that they should have to maintain their health.

For the first time, under Mi Salud, the government forced the health insurance companies to create health promotion and education programs. They had the obligation of, under this programs, identifing people who needed to access a series of preventive tests (like mamographies, pap smears, etc.) as well as to educate them about the importance of this test for the benefit of their health. Every three months, the health companies had to give the government a report that showed the results of this programs, based on the health claims of the enrollees. If they complied with what was expected, the government returned to the health companies a 5% rebate of the annual premium of the enrollees.

We asked during several months for this reports (the four quarterly reports of the first year of Mi Salud) and it took until January of this year to get some information about them. This was a huge barrier for us because we needed those documents to corroborate how the preventive medicine was moving under Mi Salud. Luckily, it helped us to prove what we were looking for.

Mainly, only 12% of the enrollees of Mi Salud went to a preventive medical appointment during the time investigated. Also, we found out that 49% of the pregnant woman enrolled in Mi Salud arrived late to prenatal care, when they were under the second and third trimester of their pregnancies. We also found out that there was a high use of the emergency room under Mi Salud.

When the stories were published, we got a lot of feedback from our readers. On our webpage (www.elnuevodia.com), enrollees of Mi Salud, as well as providers, acknowledged the importance of the preventive services. Many patients said that, because of barriers in their access to their primary doctors, they go to the emergency room looking for a doctor who could solve their medical problems. The providers, meanwhile, claimed that there are a lot of shortfalls within Mi Salud that need to be addressed first. For example, the enrollees need much better access to medical specialists. Because of low fees under Mi Salud, there has always been difficulty getting specialist to sign contracts with Puerto Rico's Health Reform.

Overall, the stories helped the public to understand the importance of preventive medicine and access to services. The stories showed that the government needs to emphasize even more on this important aspect if they want to keep enrollees healthy. As the story said, it's a dual benefit, first, for the health of the people, and second, for controlling costs in a system with a weak fiscal system.