Puerto Rico Information
Introduction to Puerto Rico
Puerto Rico, which is officially known as The Commonwealth of Puerto Rico, is strategically located on the northern edge of the Caribbean Sea. When Columbus (Cristobál Colón) landed on the island in 1493, Puerto Rico quickly became Spain's most important Island (port) in all of the Caribbean because of the island's location and natural attributes. This island is close to the deepest submarine depression in the North Atlantic Ocean. The Puerto Rico Trench reaches the depth of 27,493 feet (8,380 meters) which has given the island the biggest and best natural harbors in the Caribbean. Despite Puerto Rico’s relatively small geographical size, it contains a long and rich history which has contributed to its diverse and unique culture. Puerto Rico is a multicultural society that has been molded and influenced by: Taino Indians, Spaniards (and other European nations), Africans, and since 1898, Americans when Spain ceded Puerto Rico to the United States. With over 500 years of European colonialism and contributions from four different civilizations, the islands society and culture has evolved into a unique melting pot that laid the foundations of what is now Puerto Rico.
Before the arrival of Christopher Columbus in 1493, the Islands (one main island surrounded by numerous smaller ones) were called by the native Taino Indians as Boriken or Borinquen, which means land of the great lords, but when the Spaniards arrived they changed the name to Saint John the Baptist (San Juan Bautista) and called the main port city as Puerto Rico (which means rich port). In 1521, the two names were switched, the main island took the name of Puerto Rico and the main city was named San Juan.
Puerto Rico has become a major destination for travelers and expatriates. Puerto Rico's geographical location and its long history have created a rich and unique culture that has compelled many visitors and expatriates around the world to visit or move to this island. There are not many other countries on earth that can offer the visitor or expatriate as much to see and do in as little space as this island can. Puerto Rico can give the traveler or the resident the ideal year round weather where the average temperature throughout the year is 82.4 °F. Puerto Rico is replete with white sandy beaches, blue transparent waters of the Atlantic Ocean and the tranquil waters of the Caribbean. On the Eastern side of the island you can enjoy the cool blue surfing waters of the Atlantic Ocean where you can surf at Playa Quique Bravo in Rincón which is one of the top beaches in the world for surfing and wind surfing.
Puerto Rico is full of history. There were remains found that are believed to be from an ancient man dating back some 4,000 years. The islands have been inhabited for centuries by native Indians. Spanish Colonialism started over 500 years ago in 1493; long before the Mayflower landed on Plymouth Rock (United States) in 1620 A.D. Puerto Rico quickly became an important strong hold and port for the Spanish Crown. Many enormous forts and walls were built around San Juan because many European enemies such as the English, French, and Danish had attempted to capture this valuable port. There were so many enormous walls built around the city that many have called San Juan the "walled city". The walls and forts still stand today and are major tourist attractions.
Puerto Rico's rich diverse culture and history is a tourist attraction. Where ever you go in this country its Indian, Spanish, African and American influences will be present from: the people, language, architecture, food, and its music.
Puerto Rico is a fascinating country with a picturesque landscape complete with white sandy beaches and ideal year round temperatures. Puerto Rico is culturally diverse, with a long and rich history which makes it an ideal vacation destination. But, whether you are traveling or moving to a foreign country, it will be useful for you to understand the local laws and customs, as they can be very different from what you are familiar with. To help make your trip to Puerto Rico that much more pleasurable we have included some travel and advice tips below.
Please take note that the travel advice contained on this page may be liable to change, as such you should consult your travel expert or your local embassy prior to departing on your journey.
The U.S. Department of Health and Human Services has estimated that around 10,000 people in Puerto Rico were living with AIDS/HIV (2004). The Centers for Disease Control and Prevention (CDC) estimated the AIDS/HIV rate for adults and adolescents living with the infection were 324 per 100,000 of the population. Since the AIDS/HIV was discovered in the 1980s, 28,953 cases have been reported in Puerto Rico and over 17,834 people have died of AIDS/HIV related complications. Drug use on the island has accounted for 40% of the AIDS/HIV incidences among males and 27% of new infections among females. In 2006, Puerto Rico had an AIDS/HIV incidence rate double that of the mainland of United States.
You may need to get the following vaccinations and medications for vaccine-preventable diseases and other diseases you might be at risk for in Puerto Rico: Hepatitis A and B, Typhoid, Rabies, Rubella (MMR), Diphtheria, and Pertussis.
Hepatitis A occurs throughout the Caribbean and is the second most common travel related infection. Hepatitis A is a viral infection of the liver that is usually acquired by ingestion. Symptoms may include fever, malaise, jaundice, nausea, vomiting and abdominal pain. Most cases resolve without complications, though Hepatitis A occasionally causes liver damage.
Diarrhea is the most common infection for travelers. A few loose stools usually will not require medical treatment and it is suggested that you drink plenty of fluids such as bottled water and an oral re-hydration solution containing a lot of salts and sugar. If you start having more than four or five stools a day you should start taking an antibiotic (usually a quinolone drug) and an anti-diarrhea agent (such as loperamide). If diarrhea is bloody or persists for more than 72 hours or is accompanied by fever, shaking chills or severe abdominal pain you should seek medical attention. Food and water are the leading cause of illness it is best to wash your hands with soap and water or an alcohol base hand gel before eating. Do not eat food purchased from street vendors and make sure food is fully cooked.
Many doctors and hospitals will expect payment in cash, regardless of whether you have travel health insurance. If you develop a life-threatening medical problem, you’ll probably want to be evacuated to a country with state-of-the-art medical care. This could cost tens of thousands of dollars, so be sure you have insurance that covers this before you depart.
Travelers should be aware of tropical diseases which can particularly become present during the wet seasons. The hurricane season normally runs from June to November. Visitors traveling to Puerto Rico during this time should be prepared to face extreme weather conditions.
Overexposure to the sun is the most common health hazard in Puerto Rico but, it is one that you can avoid. Use sunscreen at all times especially if you have skin that is sensitive to strong sun, bring along sun protection with high SPF.
There is a high crime rate in capital city of San Juan. Tourists are more often targeted for petty crimes and not violent attacks. However a pregnant tourist visiting from United Sates (Georgia) was kidnapped while out for a jog and later found dead with her throat slashed in 2009. We advise that you not to carry valuables or wear jewelry in public places. Do not carry credit cards or cash cards unless you must, as people have been forced by thieves to withdraw cash.
Possession, use and trafficking of controlled drugs are all serious criminal offenses. The possession of even a small amount of drugs could result in a prison term. The penalty for carrying narcotics into or out of the country can be 20 years of imprisonment and there are usually expensive fines as well.
If you carry prescription drugs, keep them in their original container, clearly labeled with the doctor's name, pharmacy, and contents.
Emergency contacts: Department of Health: 787-766-1616, Medical emergencies: 787-754-2550, Dental emergencies: 787-795-0320, Fire department: 787-725-3444, Police: 911 or 787-343-2020, Tourist Zone Police in Conado: 787-726-7020, Tourist Zone Police in Isla Verde: 787-728-4770, Weather: 787-253-458
The healthcare system in Puerto Rico before being ceded to the United States of America in 1898 was extremely basic or non-existent. There was no agency responsible for the general health of the country and no organized healthcare infrastructure to provide access to services. There were not enough doctors and nurses in the country, especially in the rural regions. Most of the doctors and nurses that were in the country were from foreign countries that volunteered or were employed by not-for-profit organizations. When Puerto Rico became a territory of The United States in 1898, the mainland acquired an inadequate and neglected healthcare system that was geographically discriminated, where the only adequate medical treatments that were offered were only in the major cities, specifically San Juan. Puerto Rico's local government with the help from the United States set out to improve the infrastructure of the healthcare system in order to raise the standards of health.
The Puerto Rican government started to implement and lay the ground work to the foundation of its healthcare system in1912, with the establishment of the Department of Health (DOH) as the public agency responsible for the health of the population and regulating the policies of the healthcare system. It ensures access, equity, and participation to the medical facilities. It also certifies the healthcare facilities such as: hospitals, pharmacies, laboratories, diagnosis centers. In 1952, the healthcare system started to develop and grow rapidly in providing health services to the population of Puerto Rico, after the Department of Health acquired constitutional rank when the Constitution of the Commonwealth of Puerto Rico was adopted.
Puerto Rico's healthcare system is generally divided into hospitals that are financed and provided by the public sector (government) and hospitals/clinics that are financed and provided by the private sector. Healthcare providers in the public sector include: Government of the Commonwealth of Puerto Rico, municipal governments, and the Federal Government of the United States (Medicare). The United States Government is the largest source of financing to the public sector with 62% of the total public spending. The Commonwealth Government (Puerto Rico) ranks second, accounting for 37% and the 78 municipal governments contribute only 1%. The public sector, which was the dominant sector, has typically aimed at meeting the medical needs of the poor. Puerto Rico’s indigent (poor) population has relied exclusively on the local government for their healthcare needs. However, beginning in the late 1950's the private sector started to flourish and offer better, but more expensive, medical services. The financial expenditure to the private sector consists of out-of-pocket payments that are directly coming from the population and insurance plans that are paid by: private companies, corporations and wealthier individuals. Most of the expenditure to the private sector is coming from out-of-pocket expenses from the population that are unable to afford to pay for a health insurance plan or chose to pay for the better services that are offered in the private medical facilities.
The Puerto Rican healthcare system did start with some obstacles but it has made great strides forwards in improving the health of the country's population. The public sector (government) currently has 1,000 physicians to provide health services to 1.8 million people in Puerto Rico, while the private sector employs 7,000 physicians to provide services to the other half of the population (insured or out-of-pocket). There are now over 67 hospitals in Puerto Rico, of which 12 are public and 56 are privately run (16.7% are public and 83.3% are private). There are over 770 clinical laboratories and 1,104 pharmacies throughout Puerto Rico. Puerto Rico has spent over USD$ 300 million dollars on modernizing its medical equipment in both the public and the private sectors. The life expectancy is 78.58 years, which is higher than the mainland United States. The infant mortality rate was lowered from 13.4 deaths per 1,000 live births, in 1990, to 8.37 deaths per 1,000 live births in 2004, which ranks Puerto Rico 133rd out of 179 countries. The contraceptive rate for women is at 78%, ranking Puerto Rico 4th out of 57 countries. Deaths from AIDS/HIV have been greatly reduced, as have the number of new HIV infections since the creation of the Office of AIDS/HIV and Communicable Diseases in 1990. Most of the communicable diseases have been eradicated. Malaria is not an endemic disease in Puerto Rico and no cases of Malaria have been reported since the year 2004. Today the major causes of death are non communicable diseases such as: cardiovascular, cancer, diabetes, obesity, and cerebrovascular disease (hypertension).
Although Puerto Rico has made significant progress in the care of its population, its healthcare system is not perfect and there are disparities in the access to treatment and the quality of its medical services. Through the years the private sector started to become more efficient and was able to provide a higher quality of medical treatment than the public sector. During the same time, the public sector (government run) became inefficient, over funded, under staffed, inadequate, and lacked the proper medical equipment that was needed. To combat these issues, starting in the 1990's the government moved in a new direction in order to find a better way to provide the proper medical treatment that was needed. Reforms to its healthcare system were put in place with the goals to: improve the inequalities of its medical services, ensure access to medical treatments in the rural poorer regions, improve the quality and the efficiency of medical services, and to increase the effectiveness of its healthcare system through competition. Consequently, In order improve the situation and with the belief that the Government run (public sector) was inefficient and very costly, the Puerto Rican government proposed and implemented the privatization of the public healthcare system which consisted of selling the government owned hospitals and medical centers to local and overseas (United States) investors. What this means is that the Puerto Rican government relinquished all the responsibilities of providing the proper medical services to its population and put various, for profit, private companies, such as The Health Insurance Administration of Puerto Rico (ASES), in charge of the healthcare system and the health of the entire population of Puerto Rico.
The changes have caused the Puerto Rico's healthcare system, which was once exclusively run by the government, to become now more similar to the U.S. healthcare system. Now the private sector accounts for 74% of the total expenditure in the healthcare system. Today the privately run health sector is the dominant player and in order to get the adequate medical treatment needed, Puerto Ricans, of which over 50% are living under the poverty level, now have to take out their own forms of medical insurance instead of depending or relying on the government.
After two decades of reforms to the healthcare system in Puerto Rico there have been little improvements to the health on the population. Problems in accessing the medical services, efficiency and equity still persist despite the considerable resources invested. Even though the government has invested approximately US$ 300 million to purchase highly sophisticated diagnostic equipment, the vast majorities of these resources are not evenly distributed and are concentrated in the major cities while the rural regions are lacking basic hospital office resources such as: printers, photocopiers, personal computers, Internet access, and others. The vast majority of the hospitals and medical clinics are concentrated in San Juan. The San Juan region has the highest proportion of hospitals to population, with a ratio of 1 hospital for every 40,420 inhabitants, while in the Bayamón rural region, the ratio is 1 per 120,144 and San Juan has over 40% of all the hospital beds available in all of Puerto Rico. Puerto Rico itself ranks fairly low in quantity of hospital beds despite being a high income country, with 3.32 beds per 1,000, while the African country of Congo, which is considered a poor country, has 3.35 per 1,000. On top of this, due to the low salaries, especially in the public sector, and the lack of medical schools in Puerto Rico there has been an outflow of doctors and other medical professionals to other countries or the private sector where they can be paid more. Puerto Rico's only has 1.75 doctors per 1,000 people which is slightly more than French Polynesia (1.7 per 1,000) and below, the poorer income, Dominican Republic (1.88 doctors per 1,000). Also the majority of doctors (75%) and other health professionals (71%), who have stayed in Puerto Rico, have left the public sector and have chosen to work in the private sector.
While the private sector served the 37% population that could afford to pay for health insurance, there are over 8% of the population with no health insurance at all and lack the means to afford it. Even though over 70% of the population had a government medical plan, many have been turning to the private sector and paying out-of-pocket for adequate but expensive medical treatment. The largest expenditure on healthcare now is coming directly from the pockets of the population and going towards paying for: medicines (which are the costliest expense), followed by medical services and hospital stays.
Many of the implemented changes to the healthcare system have not improved the number of uninsured and underinsured persons in Puerto Rico. The Reforma de Salud is a public health insurance plan that was implemented in 2005, was enacted to extend the coverage of healthcare to the poorer segments of the population, but it only covered 40% of the population. Many of the changes to the healthcare system have actually increased the number of people without insurance and most of the population in Puerto Rico is unsatisfied with the healthcare system because adequate medical treatment has become too expensive and inefficient while access is not equitable. A major issue is AIDS/HIV in Puerto Rico, where despite the rates having gone down, AIDS/HIV incidences remain more than double that of the incorporated United States. If over 50% of the island’s population are considered poor, many are often unable or unwilling to seek medical treatment which can cause things to get much worse.
The government run hospitals in Puerto Rico may not be able to provide you with the proper medical treatment that many travelers and expatriates have come to require. Emergency medical treatment on the islands are not readily available outside the main urban centers, and you may have to be moved to a major city for medical treatment. Treatment in private clinics and hospitals is highly recommended for adequate medical treatment but will be quite expensive. Many of the doctors and hospitals will typically expect payment in cash, regardless of whether you have travel health insurance. This could cost tens of thousands of dollars in some cases, so be sure your insurance can cover this possibility before you depart.
If you are considering visiting or relocating to Puerto Rico you may have already arranged the accommodations needed, but you may not have given much thought to what might happen if you needed access to medical treatment once you arrived. You should seek medical advice before traveling to Puerto Rico and ensure that all appropriate vaccinations are up-to-date.
International Health Insurance
While traveling overseas or working in Puerto Rico, expat health insurance plans can offer you some of the most comprehensive insurance benefits and coverage. We can offer you a variety of personalized healthcare insurance plans to you and your family. Globalsurance will be able to cater to your specific and individual needs as we can offer you all the benefits that experienced travelers have come to request. If you would like to find out more about Puerto Rico, expat health insurance options or free comparative quotes, contact us today.