The healthcare system in the Dominican Republic
If you are moving to the Dominican Republic, one of your primary concerns is likely to be the healthcare system and what services are available. The country has excellent healthcare services, but only in some places, so you should consider this when deciding where to live. Obviously, nobody wants to be thinking about emergencies and accidents when moving to a tropical paradise. Still, in case you'll ever find yourself in need of help, it is better to know where to ask for it!
General
Over the past couple of years, healthcare has improved a lot in the Dominican republic. It is definitely way ahead of the systems in neighboring countries like Haiti, for example.
The services offered by healthcare providers in the DR will likely be more affordable than in Europe and the US. However, this does sometimes come at a price, as the standards won't always be the highest depending on the region.
Lately, more and more so-called health tourists, mainly from the United States, are coming to the DR to get their dental services done. This medical field is considered to be very well adapted and comes with good value at lower costs than in the US.
Healthcare in the Dominican Republic has a two-tier system. This means the government provides essential services to every person in the country, and you can upgrade if you want additional care, which usually includes better access and overall quality. Take into consideration that government-paid healthcare might be free but definitely is below the standards of a first-world country.
Most of the time, these public clinics provided by the government are marked by a lack of staff, medical equipment, and also medicine. It could even happen that the patient has to make sure they have their own supplies! It is not uncommon for Dominicans to take care of their loved ones when they are in hospital and bring food, medicine etc.
You can find the best hospitals (first-class private clinics), which offer the latest technology and methods, well-educated and experienced staff in the city of Santo Domino as well as in Santiago, another main city in the Dominican Republic. Most of the personnel will be able to communicate fluently in English, and many of them got educated abroad, probably in the United States. So if you are facing major surgery or something serious like a transplant of an organ, these types of clinics will be the ones performing them.
Also, in Punta Cana or Puerto Plata, two major tourist areas, you'll have excellent healthcare facilities and are among the top-rated clinics in the entire Dominican Republic. The hospitals probably won't be the same size as the ones in the bigger cities, but at least you can be assured to find English-speaking staff to make sure to explain your health issue adequately and get the necessary attention. Be aware of the prices in these hospitals, as they are mainly built for tourists and foreigners. They will probably charge you way higher than a regular clinic would do.
Public hospitals
Basically, there are four different types of health care available: public hospitals, tourist area clinics, private clinics, and major public/private hospitals.
There is a public hospital available in every large town, and the medical treatment is free, but usually, medication, x-rays, stitches, etc., have to be paid for. Some hospitals do not charge for x-rays and stitches. The standard of care is average at best, and they should only be used in dire emergencies. The in-patient has to provide their own sheets, pillows, toilet paper, food, etc., and their family members basically look after them. It is doubtful that any English will be spoken here.
World-class hospitals
The second type of hospital is the major world-class hospital which is located in the two major cities of Santo Domingo and Santiago. These hospitals have the latest equipment and top medical professional staff. They have private facilities along with public facilities, but they are not free, although all take medical insurance. Nonetheless, they are still significantly cheaper than the United States, for example. These hospitals will carry out everything, including heart operations and organ transplants, and some, although not all of the staff, can speak English. So these would probably be the best choice if you're in need of attending a more severe matter.
Tourist hospitals
In the touristy and heavy expat areas, there are private clinics where all or most of the staff speak English. Although they do not have the same high standards as the hospitals in Santo Domingo and Santiago, they are usually of high quality with a good standard of patient care in private rooms, with operating facilities, and intensive care units. They will usually be more expensive than the private clinics mentioned below but are often the best choice in case of an emergency, mainly because the staff will be able to offer their services in English, which can be a crucial factor when experiencing health issues.
Private clinics
The final type of hospital is the private clinic, used by the local people who do not want to go to the public hospital. There are usually 3 to 5 in each town, and they are of a higher standard than public hospitals but are generally unable to deal with anything overly complex.
Consultations
All of the different types of hospitals offer consultations, usually by specialists rather than General Practitioners. Most do not keep files on patients, and rarely is a consultation made without analysis of blood, x-rays, and other tests.
In-patient care
All Dominican hospitals will always put patients on a saline drip immediately and will almost always administer IV antibiotics, whatever the problem is, even if it might not require saline drops or antibiotics. In addition, the nursing staff does not perform the same duties as in the UK and USA, in that they only administer the injections, change dressings, etc. The family is supposed to look after the patient, bathe them and provide food, and most family members will stay with the patient around the clock.
Family doctors/ general practitioners
These types are not very common in the Dominican Public, and you might find them in more rural zones of the country. The best advice is to find yourself a physician that specializes as an internist and start seeing him as your general practitioner because they can send you to another specialist to treat your problem in case they are unable to do so. You can also look for one clinic that offers various services and specialists, so you'll have all you need under one roof. Apparently, the tradition of word-of-mouth to choose a clinic is still the best way in the Dominican Republic. Ask acquaintances or friends, and neighbors to help you find your way within the world of healthcare in the DR.
Pharmacies
Pharmacies are called farmacias in Spanish and are available everywhere, with even a small town having around 20. They have long opening hours, and many also have delivery services. In addition, colmados will also have some essential medicines such as antibiotics, cold and flu aids, and painkillers in most convenience stores.
Almost all medicines are available over the counter, including strong painkillers, antibiotics, steroids, anti-inflammatory drugs, and sleeping pills. The only drugs which require a prescription are narcotics such as morphine, although some pharmacies will also provide this without a prescription even though it is against the law. Most pharmacies will also prescribe medication simply upon you telling them or showing them the problem, which saves a trip to the doctor.
It is not necessary to buy a whole packet of tablets, and they are all sold singly. A typical antibiotic, anti-inflammatory, or blood pressure pill will cost RD$10 (US$0.20). Most pharmacies will give discounts for cash as opposed to credit card payments, so it is always worth asking for that as they may 'forget' when they see a foreigner.
As well as brand names, there is also a wide range of generic drugs, but it is thought that around 30% of all medicines in the country are fake, so you should take care to check what you are buying.
Health insurance
In recent years the government has introduced a social security system whereby workers and employers contribute to providing basic levels of health insurance. However, they do not cover the cost of treatment in full. People who earn less than RD$4.000 monthly are entitled to free healthcare paid for by the government. In case you have a job, the company might offer you an iguala, which is a paid-for monthly health subscription. There is a wide range of health insurance policies for expats and those who do not have social security. Some of the leading health insurance providers are:
- Allianz Care
- April MTC (My Travel Cover) - for less than 12 months cover
- April MHI (My Health International) - for more than 12 months cover
- Cigna Global
Consider looking at their offers according to your needs and getting a free quote on Expat.com's Health Insurance for expatriates in the Dominican Republic page.
It is first worth checking which policies are accepted by the clinic you are most likely to use, as not all clinics accept all policies. Then you can choose your provider and the level of cover you require. Insurance is very reasonable, starting at around US$100 every three months per person, for an average level of cover.
Medical tourism
This is a fast-growing area, especially for dentistry, laser treatment, and cosmetic surgery, as well as other procedures, given that the price is so much less than in some neighboring countries, and the level of expertise is of a high standard especially in dentistry.
Vaccinations
Foreigners wishing to settle in the Dominican Republic are strongly advised to be vaccinated against Hepatitis A and B and typhoid. Malaria is only present usually along the border with Haiti, and anti-malaria pills are generally not needed. Rabies is present, but there is, on average, only one human rabies case every few years. Cholera and the mosquito-borne illnesses of dengue, chikungunya, and zika have sporadic outbursts but usually mainly in the poorer areas where there is a lot of stagnant water in the streets and yards and a lack of sewage collection and regulation.
Emergency
Over the last couple of years, a 911 emergency system has been rolled out throughout the country. At the time of writing, it is available in Santo Domingo, east to Boca Chica, and west to San Cristobal. It is also now in Santiago and Puerto Plata and will eventually be available in the whole country. The DR offers these emergency services for the police, ambulances from the Red Cross, and firefighters. Unfortunately, it is not as reliable as you are probably used to. If you find yourself in a more rural area of the country and in a situation that requires medical attention, your best shot could be to pay for a cab that brings you to the nearest hospital or medical center.
Some pharmacies offer a 24-hours delivery service for urgent matters so that you can get your medicine hassle-free right to your doorstep. This service usually only exists in major cities.
Private transport with ProMed is also an option. They offer their services in La Romana, Santiago, Santo Domingo, and Puerto Plata, but you will have to pay the expenses for the transportation upfront.
Useful links and addresses:
911 - General emergency number
World-class hospitals
Santo Domingo
Clinica Abreu, Calle Beller #42
Tel: 809 688 4411
Calle Pepillo Salcedo
Tel: 809 565 9989
Santiago
Hospital Metropolitan de Santiago (HOMS)
Autopista Duarte
Tel: 829 947 2222
Clinics in expat/tourist areas
Puerto Plata
Tel: 809 586 2342
Sosua
Tel: 809 571 4696
Punta Cana
Tel: 809 686 1414
Pharmacy chains and locations
