The Institute for Health Metrics and Evaluation has shared a sobering prediction of the population of Puerto Rico over the 21st century. Based on a range of factors, they see the population falling from a high of 3.9 million in 2006 to a mere 1.1 million in 2100.
An aging population
The first factor influencing this prediction is Puerto Rico’s aging population. With more than 22% of the population over age 65, Puerto Rico has the oldest population in the nation. Younger people are more likely to leave the Island for better professional opportunities, better healthcare, and the other advantages of living in a state. If Puerto Rico continues as a territory, this trend is likely to continue.
Life expectancy in Puerto Rico is 80.16 years — higher than the United States as a whole. However, chronic diseases such as heart disease, stroke, cancer, diabetes, asthma, arthritis, and Alzheimer’s disease are the primary causes of death in Puerto Rico and they are more prevalent in Puerto Rico than nationwide. Meanwhile, the rates of these conditions have also increased throughout the U.S. For example, heart disease increased by 25% between 2011 and 2021. Chronic kidney disease increased by 27%. The IHME does not expect the life expectancy of Puerto Ricans to improve over the course of this century.The prevalence of most of these conditions increase with age,
Puerto Rico also has the lowest birth rate in the country, with just .9 children per woman. The IHME expects this figure to drop to .8 by the end of the century.
One spot of good news is that mortality rate for children under five have improved and is expected to continue to improve. Still, the total number of young children is expected to continue decreasing.
These demographic factors are enough to make a continued drop in the population likely.
Health care investment
Puerto Rico’s healthcare spending is primarily government led, whereas in the U.S. as a whole government expenditures are about equal to private insurance payments. The effectiveness of the health system, by IHME’s reckoning, increased significantly between 1990 and 2010 but only slightly since then.
We know that Puerto Rico is largely reliant on Medicaid for health care, but does not receive the same level of funding as the states. The number of doctors in Puerto Rico has decreased by 46%, according to the Center for a New Economy. One of the main reasons is that Medicaid and Medicare reimburse Puerto Rico’s healthcare professionals at a much lower rate than in the states. Working conditions are often difficult, with a lack of equipment and materials creating frustration for medical staff.
Out of pocket payments for healthcare services are a small percentage of the total in Puerto Rico and in the United States as a whole, but the higher poverty level in Puerto Rico further limits this option on the Island.
Territory status
Is the dismal state of health in Puerto Rico related to the Island’s territory status?
BioMed Central Public Health recently published a study on this question. “Puerto Rico, a US territory, faces numerous challenges adversely affecting public health, including poverty, a fragile healthcare system, inadequate infrastructure, a debt crisis, and vulnerability to climate change-related natural disasters,” the researchers concluded. “This may be a consequence of a decline in health services after natural disasters and socioeconomic downturns on the island.”
Factors relating to the Island’s political status:
- As a territory, Puerto Rico receives limited Medicaid payments from the US government, which are capped regardless of patient population and haven’t kept pace with rising healthcare costs.
- Puerto Rico’s residents pay Federal Insurance Contributions Act (FICA) taxes, which are composed of Medicare and Social Security taxes, but they do not receive the same Medicare resources available stateside and do not have voting representation on matters involving the federal budget, which further limits their ability to advocate for federal healthcare funding.
- Territory status limits economic opportunities, contributing to poverty and a lack of access to health insurance for some residents. Factors like poverty, unemployment, and inadequate housing can have a significant impact on health outcomes. These issues are prevalent in Puerto Rico.
- There are geographic disparities in access to healthcare, particularly in rural areas. A shortage of healthcare professionals further limits access to quality care.
As a state, Puerto Rico would have more secure federal funding, greater prosperity, and stronger infrastructure. As an independent nation, Puerto Rico would have to start from scratch to create a new healthcare system and supporting infrastructure. A foreign country would also expect to receive fewer resources than a U.S. territory, Yet if Puerto Rico continues in unincorporated territory status for the rest of this century, as it has for more than a century already, the dismal predictions of the IHME may prove accurate.
