Santo Domingo, Dominican Republic – Sky-high co-payment fees and unregulated, out-of-contract medical price surcharges are pushing thousands of Dominican families covered under the national Family Health Insurance (SFS) into avoidable financial strain, a crisis that top social security regulators are now prioritizing with targeted policy interventions and stricter enforcement frameworks. The push for reform was sparked by a recent investigative report from local outlet Listín Diario, which cited a technical analysis by leading health policy specialist Dr. Pedro Ramírez Slaibe projecting that total unplanned out-of-pocket costs for SFS members could surpass 24 billion Dominican pesos by 2026 if left unaddressed. Eddy Olivares Ortega, Dominican Minister of Labor and President of the National Social Security Council (CNSS), laid out a series of ongoing and planned actions during official remarks, framing the reduction of patients’ direct medical expenses as a non-negotiable institutional commitment. Olivares explained that the CNSS has already rolled out a slate of binding resolutions to ease financial burdens in recent years: 2022’s Resolution No. 553-02 cut variable co-payments for high-impact services including hospitalizations, cesarean sections and major surgeries by 50%, capping maximum required member contributions at one minimum wage, down from the previous two. That protection was expanded in 2023 via Resolution No. 581-03, which locked in the co-payment cap reduction and further lowered out-of-pocket exposure for patients accessing complex, high-cost medical procedures. Most recently, 2025’s Resolution No. 624-02 raised the system’s recognized reimbursement rate for general, specialized, dental, psychiatric and psychological outpatient consultations from RD$500 to RD$750, with 100% of the cost increase absorbed by the social security system rather than passed on to insured members. Olivares also confirmed the CNSS has formally directed the Superintendency of Health Insurance for Labor Risks (SISALRIL) to conduct a full top-to-bottom review of the Dominican Social Security System’s Basic Health Plan (PDSS), to add high-demand, innovative new medical procedures to covered benefits. He emphasized that the council is launching multi-stakeholder dialogue forums with all actors in the Dominican Social Security System (SDSS) to co-design additional sustainable reforms that expand coverage, prioritize support for low-income and chronically ill households, and prevent medical events from pushing families into debt. Parallel to the CNSS’s policy expansion work, Elías Báez, Director General of the Directorate of Information and Defense of Social Security Members (DIDA), condemned unapproved extra fees charged by in-network medical providers as fundamentally unfair, noting that many providers who sign formal contracts with Health Risk Administrators (ARS) to join the public social security network are illegally charging patients unlisted surcharges for services that are already supposed to be covered, including double-billing patients for follow-up visits to receive test results. Báez clarified that providers who choose to opt into the regulated social security system agree to pre-negotiated, publicly posted reimbursement rates, and are not permitted to pass on any unapproved cost gaps to patients, even if they argue the official fee levels are too low. He noted that legitimate debates about adjusting professional medical fees belong in formal multi-stakeholder spaces including the National Committee on Professional Fees, rather than being unilaterally imposed on vulnerable insured patients. Báez stressed that long-term solutions do not stop at raising reimbursement rates: the system needs transparent, universally understood rules, clear caps on any permitted patient cost-sharing, and a strictly enforced system of consequences that penalizes both non-compliant providers and ARS administrators that fail to police illegal overcharging in their networks. DIDA has already submitted a formal policy proposal to SISALRIL that would set a hard cap on extra fees for specialized consultations, ban double-billing for follow-up test result visits, and accelerate the rollout of expanded primary care services across the system. Báez also urged all SFS members to familiarize themselves with their patient rights, request formal receipts for every medical payment, and file formal reports with DIDA immediately if they encounter unauthorized overcharging.