The Dominican Republic has a three-tier public health insurance system:

• a contributory scheme (financed via payroll by workers and their employers)
• a government-subsidized scheme (for the poor, disabled, and unemployed)
• a contributive subsidized scheme (subsidized by the state but financed by technical workers, independent professionals and the self-employed)

In addition, it also has a private healthcare sector.

As an expat, it is probable that you will come under the contributive subsidized scheme. You will need to check this with your employer. If you are paying contributions into the social security system, you will be eligible for public healthcare that is largely free at the point of delivery: however, the Dominican state only puts 1% of its GDP into the public healthcare system, a low percentage in global terms, and thus a large number of people end up paying extra for their healthcare.

You can obtain low-cost generic brand medications at the government-run Promese Boticas Populares, but these do not always have the required medication in stock. The country has a number of pharmacy chains, however, including Farmacia Carol and Farmax, and you should have little difficulty in finding a local pharmacy (farmacia). You can also buy over the counter medication which is reasonably priced and you may find that you do not need a prescription for most medication, with the exception of anything containing morphine.

It can be difficult to find a local GP; many expats choose to register with a private clinic or hospital. The US Embassy in Santo Domingo publishes a list of doctors and specialists.

Given that the public system is underfunded, and suffers in terms of provision as a consequence, many expats take out private health insurance to cover their time in the country.

If you are making contributions into the system, and earn a minimum of RD 4,000 (US$85) per month, you will be entitled to access public healthcare.

As an expat, you will probably come under the contributive subsidized scheme. You should check this with your employer.

The public system covers primary and hospital care, but the country suffers from a shortage of medical personnel, with limited facilities and equipment. Patients often find that they have to pay for services, such as prescriptions, which should in theory be free.

The Dominican Republic is a popular choice for retirees, having many advantages, including a number of tax exemptions. Most expat retirees opt for private health cover, although you can purchase local health insurance (around US$100 for three months’ cover). Make sure, however, that your insurance covers you past the age of 65, as some policies have an age limit.

As an international student, you will need private insurance to cover your stay in the Dominican Republic. Contact your educational institution to see if they have in-house insurance or can recommend an affiliated insurer.

Your dependents will not be covered by your state health insurance even if you are paying contributions, so if your family is joining you in the Dominican Republic, you will need to take out private cover for them.

You may be able to access basic dental care in the public sector, but since Dominican private dental treatment is not only excellent but affordable, particularly when compared to the US, most expats choose a policy with a dental plan and access private treatment. A root canal will cost in the region of US$150. An implant will cost around US$700.

Employers contribute 7.09% of the salary and will deduct 3.04% from employees’ salaries for healthcare contributions. Quotable salaries for contributions are the equivalent of ten minimum wages. This is a compulsory scheme and you cannot opt out, but you are free to choose private cover as a top-up.

Public sector health provision is limited in the Dominican Republic and as mentioned, suffers from a lack of state investment, resulting in a comparatively poor level of healthcare when compared to the private sector. Thus most expats opt for private cover, even if they are registered with a contributory public scheme. You will find the most advanced care in the cities, such as Santo Domingo and Santiago de los Caballeros.

Your company may provide iguala (health/medical coverage) with a private clinic, but this may not guarantee that you can obtain the treatment you need: some specialist care may not be available at the affiliated clinic, for instance.

Private insurance will cover all primary and secondary care in addition to elective cosmetic surgery or dental procedures such as implants. Private medical care in the country can be costly: RD$400 to RD$3,000 for an initial visit to a private clinic, for instance. You will have access to some excellent facilities, however, such as the Hospital Metropolitano de Santiago (HOMS). Many medical personnel in the private sector are English-speaking.

The Dominican Republic is a destination for medical tourism, particularly dental treatment, which is of an excellent quality.

It is worth considering a policy which contains a medical evacuation clause, in the event of a health emergency which cannot be treated locally.

This will depend on factors such as your age and any pre-existing conditions, and the kind of package you opt for (obviously, a more expensive insurance package will give you more a extensive range of treatment and facilities). As so many variables have an effect on the cost of international private medical insurance it becomes very difficult to give accurate estimates without knowing the full details of the coverage required.

However, as a very rough guide, using a standard profile of a 40 year old British male with no deductibles, no co-insurance, a middle tier plan/product, all modules included and worldwide coverage excluding the US, a ballpark price of around £4,000/$5,000 might be expected. Were coverage to be expanded to include the US then the premium could increase to almost double that amount.

Both international and local providers cover the Dominican Republic, including:

• AETNA
• Allianz
• Cigna
• Foyer Global Health

iguala – private health/medical coverage provider by your employer