Behavioral Factors of Universal Healthcare: Causal Model of Puerto Rico Experience

摘要

In 1993 Puerto Rico became a pioneer among the United States and its territories for instituting a public health insurance funded by the state and provided by private services. Coverage was extended to all residents of the island, particularly to the medically indigent sector of society. Today this system is still struggling with challenges in access, equity, and quality of services. With the advent of President Obama's recent federal plan for health care, many parallels, questions, and lessons could be drawn from the early implementation of the 1993 Puerto Rico Health Reform. This parallel is relevant as many insurance companies operate equally in the island as in the mainland; billing, medical practices, and procedures are virtually the same. In fact, the Obama plan is extending to the island in 2010. We present results of surveys administered to patients and interviews with physicians that witnessed the move to universal health care in Puerto Rico. The research objective is to understand how universal access affects health care provider and patient attitudes, in turn affecting effectiveness of health reform implementation. This has helped us elicit key satisfiers and dissatisfiers of health reform implementation to depict a causal model for further research.