Learning to Manage
This introductory chapter explores the changes made to the national health care system of Puerto Rico as a result of the passing of the Medicare Modernization Act (MMA) in 2003—a legislation that extended the role of private contractors in the federal Medicare program. Specifically, the Act vastly expanded the managed care program in Medicare by changing its funding structure, adding additional managed care plan types, and creating prescription-drug coverage that would be administered by private companies. The chapter also examines the series of market-based—or neoliberal—reforms made in 1990s, which privatized the regional health system by closing public health facilities and by enrolling eligible beneficiaries in private managed care health plans. Because of this, privatization intensified due to market-based reforms in the Medicare program. Together, these two waves of privatization radically remade the health system on the island as Puerto Rican citizens became consumers of private insurance coverage.
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