Problems continues for the healthcare systems in Puerto Rico and the U.S. Virgin Islands a year after Hurricanes Irma and Maria, according to a new issue brief from the Kaiser Family Foundation. Services are still closed in some areas and provider shortages are presenting challenges to care delivery.
KFF said mental health is still a "crisis" in both areas. Puerto Rico saw an 18% increase in suicide deaths and a 13% increase in calls to a central suicide hotline in the nine months after Maria hit.
The hurricanes and their aftermath particularly complicated the care of patients with chronic conditions like diabetes. More than four in 10 people surveyed said a health condition appeared or worsened because of the hurricanes, according to the report.
While troubling, the findings are not surprising. The U.S. healthcare system is not well prepared for large-scale disasters, and Puerto Rico in particular already had weak infrastructure in many areas.
Hurricane Maria devastated the area in September 2017, and a third of the more than 4,600 deaths attributed to the massive storm stemmed from delayed or interrupted healthcare services, according to research published in the New England Journal of Medicine.
Even before the hurricanes hit, both Puerto Rico and USVI suffered from poor health infrastructure, a shrinking healthcare workforce, health disparities and high debt, poverty and unemployment. Nearly one-third of USVI residents were uninsured. Another issue is that providers in those areas receive lower Medicaid reimbursements than on the mainland, according to KFF.
The report found that the regions continue to face hurricane-related mental and physical problems for patients. Nearly one-quarter of Puerto Rico residents reported they or a family member needed or received mental health services after Hurricane Maria and 13% of those people needed new or higher-dose prescription medication for emotional problems after the storm.
Service has been restored in some areas and others remain closed or provide limited services, further complicating the need for care. Puerto Rico's offshore islands and the rural regions were especially left behind the rest of the territory. Federal money was critical to the recovery, but temporary Medicaid cash is expiring at the end of September 2019, which worries healthcare stakeholders, according to the paper.
Despite improved preparation efforts for the next major storm, KFF said uneasiness remains a problem in the two territories. "While improvements and preparations are in place for another storm, many feel unprepared for another major hurricane given the current status of recovery efforts," researchers wrote. "Both Puerto Rico and USVI have released longer-term recovery plans that call for additional investments in infrastructure and focus on economic recovery. While some of these initiatives are underway with current resources, it is unclear if or how many additional resources will be available to carry out these plans."
While USVI and Puerto Rico continue their recovery, Hurricane Florence remains a threat to hospitals in South Carolina and North Carolina. These facilities face potential long-term losses. A recent PwC report found that natural disasters cost U.S. hospitals nearly $200 billion in 2017. Those losses resulted from closures, damages, canceled appointments, revenue cycle disruptions and displaced workers and patients.
The Carolinas aren't out of danger yet. The South Carolina Hospital Association said rivers may remain at flood stage through the rest of the month.
At least 37 people have died as a result of Hurricane Florence. Two of the people who died in South Carolina were mental health patients who drowned while being transported in a Horry County Sheriff's Department van from Waccamaw Mental Health and Loris Hospital to McLeod Behavioral Health in Darlington.
Following the tragedy of last night’s high-water incident, Sheriff Thompson released the following information. pic.twitter.com/xpirs67W6E— Horry County Sheriff (@horrysheriff) September 19, 2018