Living on a tropical island can be exciting, refreshing and full of wonder. Famous for our natural attractions, warm people and interesting culture – over the years the Dominican Republic has been home to all sorts of people. In the last decade the country has seen a steady wave of individuals coming in every year for their vacations, and some, to stay and live with us.
Being the second largest and most diverse Caribbean country, we open our doors to expats, travelers or global nomads, especially on the North Coast. However, the healthcare subject always seems to pop up after you’ve been here long enough. And if anyone is considering living here full time they should know what’s on the table. To get more insight from the system, I decided to have a word with a few healthcare workers that perform in different areas so they could express a bit of their personal experiences here. I talked to Dr. Rofelixsa Lopez (a primary care physician/family doctor), Dr. Jefferson Genao (intensive care/anesthesiologist), Dr. Carlos Domínguez Rodriguez (psychiatrist) and Lindsay Sauvage (doula – birth companion).
When asked what common situations she gets in her daily work Lopez tells us she sees a lot of patients (about 85%) for diabetes or hypertension, including the retirees.
“I’ve noticed a lot of expats go to pharmacies to buy antibiotics but refuse to get checked by a doctor. A lot of meds are sold over the counter, but we forget how important it is to get a doctor’s check up.”
Following that line, Dr. Genao claimed that cardiovascular diseases are becoming more common, even as a main cause of death – as well as cancer. When asked if our healthcare system was good Dr. Dominguez said “it’s fine, just probably not so much for mental health.”
So, okay. Tell us:
What’s up with the Dominican healthcare system?
Being a family doctor, Lopez finds that a lot more cases should be checked on by primary caregivers, and not go straight to specialists, also that the web of public hospitals need more funds.
Dr. Lopez: “Our healthcare system can be a little complicated for people who don’t know the country. There are many hospitals and first level clinics, it’s awesome because everyone gets assistance. But some of the public ones don’t come with enough resources for certain medicines or procedures. We have limitations on that aspect.”
As a mental health specialist from Santiago, Dr. Dominguez regularly pays visits on the North Coast, mostly around the subjects of depression, anxiety and substance abuse.
Dr. Dominguez: “I think the system has been making strides on improving but has a long road ahead. Currently the Dominican College of Physicians is claiming for more coverage and – among other things – is requesting for the inclusion of mental health in the insurance plans. There is an ongoing public discourse for the need to expand psychological health nationwide. Currently we have around 300 psychiatrists in the DR, and it’s not enough.”
For Dr. Genao admits that some political interests could be getting in the way and that the system could use a little more symbiosis.
Dr. Genao: “The health care system can be a bit confusing sometimes because we have different networks functioning at the same time and not necessarily together. The government administers public hospitals that offer primary and tertiary care in the country to Dominicans and residents, it’s free but sometimes doesn’t have all the elements to perform, even though politicians may say the opposite.”
Genao also pointed out that the biggest health care providers are private clinics and hospitals. These are supervised by the public health ministry but function independently and have few (if any) collaboration between themselves keeping up with very different standards. For example: You can find hospitals with the latest technology and others with the basic minimum.
Also, if you or your partner are considering having a baby on the island, you might want to check in with your physician in advance. Natural births are not the first options in most medical centers, Lindsay Sauvage says. She has been a doula in Cabarete for a few years now; providing emotional, physical and informational support during the pregnancy, birth and postpartum period of her clients.
Sauvage: “The Dominican Health system is okay in general and depending on what services you require can be very good here but there is a wide range of variability between each doctor and how they’ve been trained. In regards to maternal and infant health the DR is behind other countries and comes with the highest cesarean section rate in the world (58% according to the WHO in 2012, while the US is at 32% in comparison). Also, in private clinics the c-section rate is probably much much higheraround 80 or 90%.”
International experts would agree that amount is beyond what should be considered necessary.
As a practitioner, would you be able to mention some elements of the healthcare system, whether positive or negative?
Dominguez: “For positive I’ll tell you we have very good bedside manners, we’re great at keeping track of our patients and trying to connect with them. Making sure they’re good and following-up.”
All of them seemed to agree on this.
Genao: “Yes, all of my patients from abroad emphasize how easily and quickly someone can see a specialist, get a complex surgery or how caring and attentive most doctors are here. But in the negative, the cost is the main obstacle for most people to access quality healthcare, especially without insurance.”
Dr. Lopez made a point on how fast most patients here can receive a daily check-up.
Lopez: “On the positive side: You can visit a center and receive medical attention within a few hours, get your tests done and results back within the same day. You don’t have to plan too much ahead of time, unlike other countries where a medical check-up can take weeks or months. On the negative side, in my case, people seem to forget they need to be viewed by first level doctors before moving on to a specialist. So, the third level hospitals (specially the private ones) shouldn’t be saturated. We could work more on referrals.”
When compared to other countries our prices are still manageable, but some processes need to be regularized.
Sauvage: “A positive element about healthcare in the DR is that the insurance system keeps prices at decent levels. For example, with a basic “emergency only” health insurance (for which an individual pays 250 USD per year) a laparoscopic appendectomy with 3 nights in the hospital plus charges and care was covered at an 80% and the person paid 8,000 RD out of pocket ($144 USD as of today – March, 2023). A negative detail about the system, more relating to health care on the north coast, is the variability in quality of care and the irregularity between doctors, diagnoses and proposed treatment.”
Any recommendations on how to stay healthy in the DR?
When asked, it seems like the basics can go a long way… Whether it’s drinking purified water from a botellón or water filter, making sure your food is properly cooked or driving sober, all of these are valid and good to keep in mind.
Lopez: “Top of the list – I recommend that you don’t drink water from the faucet and be aware when going into the ocean. Lately, I see a ton of injuries from driving motorbikes, please wear helmets and drive with prudence. Oh, and avoid raw foods and wear repellent. Last but not least: wear protection.”
Genao: “If you’re feeling sick or in an emergency, go to the closest medical center you have. If you already suffer from a condition – even a controlled one, try getting to know a trusted doctor in advance and keep an eye on things. People don’t realize, but when on vacations, yes you can be carefree but you are still prone to getting sick, having an accident or affecting your condition. This is because you are changing your routine completely and sometimes drinking more alcohol than usual.”
Staying healthy on the coast does not have to be hard, at all. In Sosua and Cabarete there are plenty of gyms, martial arts centers, schools for watersports or wellness facilities for meditation, yoga and massages. There are regular farmer’s or artisan markets with fresh (and local) vegetables & fruit, and homemade organic food selections. As mentioned there’s a couple of clinics and hospitals, some of them with very good equipment and doctors.
Some of these are: Cabarete Medical Center (CMC) the closest to Cabarete and Sosua, Centro Medico Bournigal and Centro Medico Brugal in Puerto Plata, HOMS in Santiago (which is a 2 hour drive, but still the most all-around complete center), and CEMNA in Nagua.
Feel free to get involved with the community, get to know what works for you and make use of it. Not to mention a lot of fresh air and awesome outdoor spaces to reconnect with nature and yourself.
In the end we ask:
Is healthcare good in the DR?
While it’s still a hard question to answer, first because it depends on what you personally consider “good” to be or what your needs are. But when you compare the DR healthcare in general with bigger and richer countries, yes we do have a lot of things to work on but also other aspects we’re great at. That’s where the personal trait and our natural hospitality as Dominicans comes afloat.
In the end, we can all agree that before coming to the DR (or once you’re here) make sure you get all the basic medical checks, that you eat and drink safely, prevent bug bites, select safe transportation, avoid sharing body fluids without precaution and finally, get to know your medical care while traveling. Yes – We don’t have everything figured out here. And for some, that’s still part of our charm. As in anywhere else in the world – just keep an eye out for yourself, or two.
Quick details on Health Insurance:
Speaking with Biki Dozet, owner of Absolute Seguros in Cabarete, she tells us there are 2 types of health insurance here in the Dominican Republic: “One is basic and the other is private. When registered in a company as an employee (with a cedula or dominican ID number) you automatically get the basic insurance from your employer and the government.” This one has its benefits because it starts right away, however it doesn’t have a high coverage.
Ideally you want to get a good one from a company like Humano, Universal or Maphre Salud – when you’re buying into a smaller company, they might not work everywhere. And, since we live in a small beach town – not all clinics accept every insurance.
“A lot of expats go for private insurance,” says Dozet, “and prices are the same for all, doesn’t matter if you’re Dominican, a resident with a cedula or a foreigner with a passport”. Practically, everyone can apply for a private insurance service. The only detail is that there is an age limit: Unfortunately, people over 70 years are not accepted. So if you are 69 or older, avoid making changes in your health insurance situation. But if you are within the age frame and you’d like to apply there’s several plans. “Some start from 1,000 RD (18 USD), others can go up to 10,000 RD (180 USD) which has more coverage and options. There’s something for everyone.” Dozet personally works directly with 2 insurance companies which are Mapfre and Humano Salud, she considers these to be the best.
Travelers insurance is a good option too, for people looking to come for a limited time. A pricey, but good option is International insurance which works everywhere and has great coverage. It all depends on your requirements (and budget).
Final comments: Anyone living on the island is recommended to have insurance coverage given their needs. There are a lot of pharmacies all across the country and various ways of avoiding getting sick and/or getting medical attention. Luckily, in the last few years, the DR has included the 911 emergency system to the population, which has been very beneficial for all those in need of assistance. So, feel free to enjoy everything the north coast has to offer, there’s a lot more than a beautiful beach.