Association for Public Policy Analysis & Management

The Commonwealth of Puerto Rico is a United States territory where the residents have worse health outcomes than residents of the mainland United States. The poor health status of the residents of the island has long been recognized. Specifically, Puerto Rico has higher prevalences of heart disease, diabetes, hypertension, asthma, and self-reported poor health than does the mainland United States. Yet Puerto Rico’s health system is under-researched, and the research that exists has produced different theories as to why these health disparities exist. This study explores the role of three factors that make Puerto Rico distinctive: its Medicaid block grant funding scheme, its high poverty rates, and its lack of physicians. While these factors are intertwined, the study worked to tease out each one’s direct impact in contributing to Puerto Rico’s poor health outcomes.

Methods

In order to examine the impact of each of these three factors (Medicaid funding, poverty, and physician supply) on chronic diseases, while also exploring their intertwined nature, the study collected data on these issues from the Center for Disease Control, the U.S. Census Bureau, the Center for Medicare and Medicaid Services, and the Health Services and Research Administration. I perform a fixed-effect regression with controls for extraneous variables.

Results

Results are forthcoming but this study’s hypothesis is that all three factors -- high poverty rates, block grant funding for Medicaid, and a shortage of physicians -- have negative impacts on the health of residents living in Puerto Rico. Poverty has a positive correlation with the prevalence of chronic diseases while Medicaid funding and physician supply have a negative correlation with the prevalence of chronic diseases.

Conclusions

If the results are as hypothesized, an increase in Medicaid funding would greatly benefit Puerto Rico and improve the health of the residents. Since, Puerto Rico operates under a block grant system, legislators should consider converting Puerto Rico’s Medicaid structure to that of the other mainland states who do not received capped funding.