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The Dominican health system

What should I do in the event of a medical emergency?
Dialing 711 in the Dominican Republic connects you with the Fire fighting, Police, and Red Cross ambulance services. The latter can also be reached directly by phoning 689-4288 (although the line is often engaged). Private ambulance services are available. If specialized medical equipment or care is needed immediately, be sure to tell the person taking your call. Give any relevant information and stay on the line until the other person hangs up in case there is a need to reconfirm your location or other information. Be prepared to pay the ambulance driver immediately upon arrival to your destination. 

Calling a taxi is a more economical way to reach the emergency room. Companies such as Apolo Taxi, Tel. 537-7771 and Tecni-Taxi, Tel. 566-0109, can often get a taxi to your home within minutes, which may be faster than the ambulance. Clearly, however, they cannot provide any medical care en route. 

The best emergency services are found at Clinica Abreu, Calle Beller No. 42 (corner of Independencia), Tel. 688-4411. UCE Medical Center’s emergency room, on the corner of Máximo Gómez and Pedro Henríquez Ureña, Tel. 688-9511, is also recommended. 

What if I need a certain medication on an emergency basis?
The following pharmacies (chemists) are open 24 hours a day and make deliveries to your home:
Farmacia San Judas Tadeo, Av. Independencia No. 57 , Tel. 689-6664, 689-2851, 686-3289, 685-8165, or 685-8166. 
Farmacia Carol, Gustavo Mejía Ricart No. 24 (at the corner of Luis Alberti), Tel. 562-6767, 562-6757, or 540-2024. 
Many others do business until midnight, and have a home delivery service. Most accept major international credit cards. The best bet is to check your own area to see what is available. 

Many drugs are available without a prescription in Santo Domingo, including antibiotics. It could be tempting to bypass the medical profession completely. Self-diagnosis, however, can be erroneous and even dangerous. If you do decide to take this path, which is not recommended, bear in mind that certain medicines are available here which have been banned in other countries. It may be preferable to ask for a specific brand name (“Tylenol”) or chemical component (“Acetaminophen”) rather than generalize (“something for a headache”). 

What should I do to ensure good medical care?
The old Boy Scout motto “Be Prepared” is the one to apply to health care. It is recommended that you obtain medical insurance as the most important first step. Particularly advantageous is a dual policy which covers medical expenses abroad. 

In the U.K. you would need to register with your local general practitioner, while in the U.S. you would probably seek out a family doctor upon arriving to a new community. 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; they should be able to guide you toward other specialists if necessary. 

You can either select doctors on an individual basis or choose a local clinic and find the appropriate personnel among the staff. Your insurance company may be able to help indicate which clinic is the most appropriate for your needs. Otherwise, ask around and find out by word of mouth which place has the best reputation and staff. 

What kind of medical services exist in the D.R.?
There are three different medical systems within this country. The first is a socialized system, mainly for the indigent and extremely poor of the country. In theory, the government provides free medical care to anyone who walks into the appropriate medical facilities. In practice, the patient may need to purchase many of the medical supplies and pay a minimum fee for services.

The second is the Social Security system, for those workers who earn less than RD$4,000 per month. Social Security only provides coverage for the workers themselves and maternity services for spouses; children are not covered. 
The third consists of private clinics, which are in reality hospitals, providing fee-for-service care. 
A new Social Security Law fuses these three types of services into one single system in which socialized-type medical care is to be provided, but this is still in the starting stage. 

How good are the different systems?
The free care which the government provides is far from adequate, although it does meet some needs, such as the provision of vaccinations and infant rehydration supplies. Facilities, trained personnel, and medicines are many times lacking. (Since most medicines are imported, they are too expensive to provide for free in large quantities). Patients may be asked to pay for materials and for their prescriptions, putting the costs beyond their financial possibilities. The government sells low cost generic brand pharmaceuticals at its Promese Boticas Populares, but the government is not known to keep the needed inventory levels of these lower cost medicines. 

The Social Security system is also far from adequate. Nevertheless, certain Social Security clinics offer good services, and even those people who have alternative medical insurance may choose to take advantage of benefits such as the provision of free milk. 

Private clinics as the most well-equipped and well-staffed, both by qualified doctors and nursing personnel. Fees, however, range from RD$400 to RD$3000 for a first visit, depending on the clinic and the specialist. It is calculated that less than 10% of the Dominican population could afford private medical services if it were not for the medical insurance programs. 

Can I get the medical care I need in the Dominican Republic?
The DR is not far behind more well-developed countries in medical care. The country has been given very good ratings by the foreign medical practitioners continuing the care of tourists who have suffered major catastrophic events while on holiday. 

In the area of surgery, the D.R. is ahead of many of Latin America in laparoscopic laser surgery. A good volume of patients come from the Virgin Islands, the Lesser Antilles and other parts of the Caribbean to take advantage of the good care and lower fees in this country. 

Dental services also offer value for money, with very good treatment and reasonable prices, factors which also attract clients from other countries. 

The vast majority of your medical needs can be met on the island. Interventions, however, requiring high-tech equipment or a long period of rehabilitation may not be available. 

What kinds of medical insurance exist?
If you are one of the workers who earn less than RD$4,000 per month, you will be making Social Security payments, and you will be entitled to the benefits of the government health services. 

Many employers provide something 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 of 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, you will in effect have no cover under the scheme. 

True medical insurance plans come in various types. One type will reimburse you for your medical expenses, possibly including your medications. This type of plan provides a 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. An individual, however, might have to pay for a year in advance rather than benefiting from a monthly payment schedule. 

Two of the largest insurance brokers are Ros & Associates, located on Winston Churchill at the corner of José Brea Peña, Tel. 567-1021 or 562-4556 and Franco-Acra & Associates, Winston Churchill 32, Tel. 535-1655.

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