Power health: VIP coverage with public funds

Santo Domingo.- While thousands of Dominicans get up early for a turn in a hospital, some officials are guaranteed medical attention abroad. Not with a common ARS. Not with a complementary insurance. But with international policies paid by the State.

And all this, amid a crisis in SENASA, according to medical unions and political actors who question the sustainability of the system. Since 2020, multiple processes registered on the purchasing portal reveal a pattern: contracting international medical insurance, some linked to specific trips and others to broader policies.

MIREX: VIP health

The Ministry of Foreign Affairs (MIREX). In the last four years alone, it has committed more than RD$4,800 million in international medical insurance.
• In 2022, it awarded a contract for RD$1,350 million.
• In 2021, it attempted to award another for RD$720 million, later canceled.
• And in 2025, it published a new tender for RD$2,750 million, currently in process. This latest contract is intended for 1,592 officials and dependents, with worldwide coverage, no deductibles, and no medical restrictions.

A Gap of Millions

The policy provides coverage of up to US$2.5 million per person per year. According to the Inter-American Development Bank, per capita public health expenditure in the Dominican Republic is around US$316 per year. In other words, this coverage is almost 8,000 times greater than what the State invests for each citizen in the public system.

In addition, it includes hospitalization, emergency services, surgery, mental health, medical evacuation, air ambulance, repatriation of remains, oncology treatments, HIV, dialysis, orthodontics, acupuncture, and more. All of that, with automatic continuity for the insured, without prior medical evaluation or surcharges for pre-existing conditions. It even allows dismissed officials to continue with coverage for up to two years, paying the same premium.

Health for a Few

The contrast is evident. According to the Composite Health Results Index 2022 (IDB), Dominican Republic obtained 67.7 points out of 100, lagging behind countries like Chile, Costa Rica, Colombia or Cuba. Medical coverage in public hospitals is limited. There is a lack of specialists in entire provinces. Operating rooms are closed due to lack of staff. Primary care units that do not open on weekends. And more than 40% of the total health expenditure is covered directly by citizens. Even so, while thousands face debts for basic medical services, others access a parallel system with foreign private clinics, without limits or waiting times.

Privilege without transparency

MIREX is the only institution that has tendered this type of insurance openly. In the rest of the State, there are no public records of similar processes. However, it is known through institutional practice that many high-ranking officials also enjoy international coverage: senators, ministers, directors, among others There is no clear policy that defines who is entitled, under what criteria, or with what limits. There is also no active transparency: the list of beneficiaries is not published, nor the total cost, nor the contracts signed.

Until today, the only entity that publicly renounced this benefit was the Social Plan of the Presidency in 2020, as part of a cutback policy. No other has done the same.