Dominican Republic Study Finds Millions in Potential Health Savings

The idea behind the study is simple but consequential: a health system can sometimes improve health without spending more if it stops paying for care that provides little or no additional value and redirects those resources toward services that produce greater health gains. In the Dominican Republic, researchers have now applied that approach to six candidate uses of health technologies in the contributory regimen of the country’s health insurance system. Their model estimates potential savings ranging from $122,113 to $8.6 million, depending on the technology considered and the assumptions used. The figures are estimates of avoidable spending, not money that has already been recovered.

What “Health Care Disinvestment” Actually Means

In this context, health care disinvestment does not mean dismantling hospitals, eliminating entire medical specialties or simply reducing the health budget. It refers to reducing or stopping payment for a technology, procedure or use of a technology when evidence indicates that it provides little or no health benefit in the circumstances in which it is being used, or when the same resources could generate substantially greater benefits elsewhere.

The distinction matters. A mammogram, chest X-ray, medicine or other medical technology is not inherently “wasteful.” The question is whether it is appropriate for a particular patient, clinical situation and purpose. A test can be highly valuable in one circumstance and unnecessary in another. The Inter-American Development Bank, which financed the research program behind the study, describes this approach as concentrating on waste so that resources can be redirected without withdrawing beneficial care from patients who need it.

That makes disinvestment fundamentally different from an across-the-board budget cut. The objective is not simply to spend less. It is to spend the same health resources more effectively, provided that the underlying clinical assumptions are correct and that changes are implemented safely.

What the Researchers Studied

The study, published in Value in Health Regional Issues, examined the potential financial and health consequences of disinvesting in six candidate health technologies in the contributory regimen of the Dominican Republic. The authors are Carolina Moreno-López, Ramon Castano, Pamela Gongora-Salazar, Úrsula Giedion, Gina P. Saavedra-Martínez and Andrés I. Vecino-Ortiz. The article was published in 2026 and is available through ScienceDirect as an open-access research article.

The researchers used a four-stage methodology. First, they identified the data required from the contributory health insurance system. Second, they established a baseline scenario representing current patterns of use. Third, they estimated the amount of waste associated with each prioritized technology and calculated the potential financial savings from reducing that waste. Finally, they estimated the opportunity cost of using those resources elsewhere by modeling their possible contribution to selected high-value health interventions.

That last step is central to the study. The analysis does not stop at the question, “How much could be cut?” It asks a more policy-relevant question: “What health could potentially be gained if the money were spent differently?” The study therefore links financial savings to measures such as reductions in coverage gaps and additional quality-adjusted life-years, or QALYs, a standard health-economic measure that combines length and quality of life.

The Six Technologies and an Important Source Limitation

The published study states that six candidate health technologies were evaluated in the Dominican Republic. However, the publicly accessible abstract does not enumerate all six technologies individually. The detailed article is hosted by ScienceDirect, but the full-text page was not accessible through the available public interface during verification. Because the study itself is the required primary source, it would be inappropriate to reconstruct the remaining four technologies from a separate country’s analysis or from secondary descriptions and present them as Dominican findings.

Two Dominican applications are explicitly identified by the study’s research program and accompanying Inter-American Development Bank material: mammography in women younger than 50 and preoperative chest X-rays. The broader study evaluates six candidate technologies, but the available primary-source abstract does not provide a reliable list of all six.

This limitation is important because a related study by the same research team examined six technologies in Colombia, including cesarean delivery without obstetric indication, preoperative chest X-rays, CT scans for headaches without warning signs, extended proton-pump-inhibitor use, antibiotics and antihistamines for colds. Those are Colombian findings and should not be transferred to the Dominican Republic simply because the research projects are related.

For Dominican readers, the clearest documented examples are therefore the two uses identified specifically for the country: mammography among women under 50 and preoperative chest radiography. The study’s headline financial estimate applies to the six Dominican candidates as a group of modeled disinvestment opportunities, not to those two examples alone.

Mammography: Why the Study Flags Use in Women Under 50

The research program reports that as many as 96% of mammograms performed in women younger than 50 in the analyzed Dominican insurance data could be considered unnecessary under the study’s criteria. That is a striking figure, but it requires careful interpretation.

It does not mean that 96% of women under 50 should never receive a mammogram. Women with symptoms, a high-risk clinical profile, a strong family history or other indications can require breast imaging outside routine screening recommendations. Nor does the study establish that every mammogram identified by the model was clinically inappropriate in an individual case.

Rather, the model identifies a potentially unnecessary use of the technology under the criteria used to define low-value care in the analysis. The finding is therefore about patterns of use, not a blanket judgment about mammography as a diagnostic tool.

The distinction is particularly relevant in screening, where the age at which routine mammography begins depends on the guideline and the population’s risk profile. Screening younger women can have benefits in selected circumstances, but indiscriminate testing can also create false-positive results, follow-up procedures and additional costs. The study’s economic argument is that resources spent on low-value use should be evaluated against what those resources could accomplish elsewhere.

Preoperative Chest X-Rays Are the Other Major Example

The second Dominican example identified by the research program is the use of chest X-rays before surgery in patients considered low risk. The study estimates that 54% of such preoperative chest X-rays could be considered unnecessary.

Again, the finding does not mean chest X-rays have no role in surgical care. A chest X-ray can be clinically important when a patient’s history, symptoms or examination indicates a meaningful possibility of a cardiopulmonary problem. The issue is routine testing in circumstances where the result is unlikely to change clinical management.

From a health-economics perspective, every unnecessary test consumes more than the price of the image itself. It also uses radiology capacity, staff time, equipment and clinical attention. If the test produces an incidental finding, it can trigger additional consultations or procedures. The study’s framework treats these downstream consequences as part of the broader opportunity cost of low-value care.

How Much Could the Dominican Republic Potentially Save?

The study estimates that reducing waste associated with the six candidate technologies could generate potential savings ranging from $122,113 to $8.6 million. The wide range reflects the different technologies analyzed and the estimated amount of inappropriate or unnecessary use associated with each one.

These numbers need to be read correctly. They are model estimates, not audited savings, cash already sitting in the health insurance system, or money that the Dominican government or insurers have already recovered.

The estimates depend on the researchers’ baseline assumptions, the available administrative data, the estimated amount of low-value use and the prices or costs assigned to the services. Actual savings would depend on whether clinical practice changed, how providers responded, whether patients received alternative services and whether the resources released were actually redirected rather than absorbed elsewhere in the system.

The Inter-American Development Bank separately reports that the Dominican Republic’s potential waste identified in this work could amount to approximately 0.5% of total national health spending. That figure should likewise be understood as an estimate derived from the study’s modeled low-value uses, not as a measured amount of money that could automatically be removed from the health system’s budget.

Where Could the Money Go Instead?

The study’s most important policy question is what happens after potential waste is identified. Its answer is reinvestment in interventions considered highly cost-effective, sometimes described as “best buys.”

For the Dominican Republic, the researchers modeled redirecting resources toward cervical cancer screening and type 2 diabetes management. According to the study, reallocating resources from the six candidate technologies could reduce the coverage gap for cervical cancer screening by up to 1.88 percentage points and the gap for type 2 diabetes management by up to 4.08 percentage points, depending on the technology and modeled savings scenario.

This is where the concept of opportunity cost becomes tangible. Suppose a health system spends money on a test that is unlikely to change the treatment of a low-risk patient. The cost is not limited to the test itself. That money could have been used for another intervention with a higher expected health return. The “cost” of the low-value test therefore includes the health benefit that the alternative intervention could have produced.

The study does not demonstrate that every dollar removed from low-value care would automatically finance the stated number of additional screening or diabetes services. Instead, it models the potential health effect of reallocating the resources under specified assumptions. The distinction is crucial when interpreting the results.

Why This Matters for the Dominican Health System

The question of health spending efficiency is particularly relevant in a system where public institutions and social insurance programs must finance a broad package of services. SISALRIL, the Superintendence of Health and Labor Risks, explains that the Dominican Social Security System‘s Basic Health Plan covers services ranging from preventive care and diagnostics to surgery, hospitalization, medicines and high-cost treatments such as cancer care, dialysis and kidney transplantation.

That breadth creates competing demands for finite resources. Expanding coverage for one intervention can require additional financing, while maintaining existing benefits consumes resources that cannot simultaneously be used elsewhere. A formal disinvestment framework offers another possible route: identifying low-value use within existing spending before asking exclusively for additional money.

SISALRIL itself has described the Dominican disinvestment research as an opportunity to improve health-system efficiency and reduce out-of-pocket spending, while examining how resources might be used to incorporate or finance new health technologies. The agency discussed the research with the Inter-American Development Bank in 2025.

The issue also sits within a wider government effort to improve the quality of public spending. The Dominican Republic’s General Budget Directorate has emphasized efficiency in health spending and reported that health-sector institutions were working on a more strategic and equitable approach to the 2025 budget.

The Scale of Health Spending Puts the Estimates in Perspective

The Dominican Republic’s Ministry of Public Health and Social Assistance had a substantial allocation in the 2025 national budget. Budget documents published by the General Budget Directorate show an appropriation of about RD$149.2 billion for the ministry under the institutional classification used in the 2025 budget proposal, with a separate programmatic presentation showing approximately RD$151.0 billion in total appropriations.

Those figures should not be compared mechanically with the study’s modeled savings. The study focuses on selected technologies within the contributory health insurance regimen, whereas the ministry’s budget covers a much broader set of government responsibilities. They belong to different financial and institutional scopes.

The comparison is nevertheless useful conceptually. The study is not proposing that the Dominican Republic can finance its health system by eliminating a handful of tests. It is asking whether a relatively small share of health spending can be shifted toward services that produce more health per dollar.

What SeNaSa and SISALRIL Add to the Picture

SeNaSa, the Dominican Republic’s National Health Insurance provider, is a central institution in the country’s publicly financed health coverage. Its transparency portal publishes annual institutional budgets and financial planning documents, including its 2025 institutional budget.

SISALRIL, meanwhile, regulates and supervises the health insurance system and publishes information on the benefits available through the Plan of Health Services. Its official guidance states that the Basic Health Plan uses a common service catalog across health-risk administrators, while differences can arise through complementary plans and the applicable insurance regime.

These institutional arrangements matter because a disinvestment policy cannot operate simply as a spreadsheet exercise. Changing the use or reimbursement of a medical technology can affect insurers, providers, physicians and patients. It requires clinical criteria, coverage rules, monitoring and communication so that reducing low-value care does not accidentally reduce necessary care.

The Difference Between Cutting Costs and Improving Value

A conventional cost-cutting policy asks how much expenditure can be removed. A disinvestment strategy asks a more demanding question: which spending produces too little health value relative to its cost?

That difference changes the policy objective. Eliminating a useful service simply because it is expensive can harm patients. Eliminating a test that rarely changes management for a clearly defined low-risk population may free resources without reducing health outcomes. The difficult part is identifying that boundary accurately and applying it consistently.

Health technology assessment is designed for precisely this kind of decision. It combines evidence about clinical effectiveness and safety with economic, social and sometimes ethical considerations to inform coverage and resource-allocation decisions. The approach is increasingly used internationally to determine whether technologies should be adopted, retained, restricted or reconsidered.

Why the Study Does Not Mean Doctors Should Simply Order Fewer Tests

The study’s findings should not be interpreted as a directive for physicians to stop ordering mammograms, chest X-rays or other tests. Clinical decisions occur at the patient level, while the research uses population-level administrative data and economic modeling.

A patient can have circumstances that make a test appropriate even when a broad category of similar tests is classified as low value in the model. Likewise, a procedure that is unnecessary for one population may be appropriate for another. A responsible disinvestment policy therefore needs clearly defined clinical criteria rather than a crude numerical target.

The study’s approach also highlights why provider engagement matters. Research on disinvestment in other health systems has found mixed results when attempts are made to reduce low-value care, suggesting that identifying waste is easier than changing clinical practice. Successful implementation can require evidence-based guidelines, clinician participation, monitoring and feedback rather than reimbursement cuts alone.

The Main Limitations of the Dominican Analysis

The most important limitation is that the study estimates what could happen under modeled changes; it does not observe a completed disinvestment program. The authors therefore cannot claim that the Dominican health system has already saved the estimated amounts or that the modeled reinvestments have already produced additional screening, diabetes treatment or QALYs.

A second limitation is the scope of the data. The analysis focuses on the contributory regimen rather than every source of health spending in the Dominican Republic. Its results therefore cannot automatically be extrapolated to the entire public sector, the subsidized insurance regime or private out-of-pocket spending.

A third limitation concerns implementation. Identifying potentially wasteful use does not establish that the same amount of money can be recovered in practice. Some costs are fixed, some are tied to infrastructure or staffing, and some savings may disappear if providers simply substitute another low-value service.

Finally, the headline estimates should not be interpreted as causal evidence that disinvestment itself would produce the exact health gains modeled. The analysis is an economic simulation based on observed patterns and assumptions about alternative uses of resources. Its value is to inform policy choices, not to guarantee their outcomes.

What a Successful Disinvestment Policy Would Require

If the Dominican Republic were to translate this research into policy, the most important step would be to turn the model’s findings into transparent clinical and reimbursement rules. That would require defining which uses are low value, identifying exceptions, communicating the criteria to providers and monitoring what happens after implementation.

The process should also distinguish between reducing inappropriate use and restricting access. A woman under 50 with a specific clinical indication for breast imaging should not be treated the same way as a low-risk patient receiving routine screening without an indication. Likewise, a preoperative chest X-ray can be justified in a patient with relevant symptoms or medical history even if routine imaging is unnecessary for a low-risk surgical patient.

Reinvestment is equally important. If savings are identified but simply disappear into a general budget, the health benefits modeled in the study may never materialize. The economic logic of disinvestment depends on linking the resources released from low-value care to interventions with demonstrably higher expected value.

Why Cervical Cancer Screening and Diabetes Management Matter

The study chose cervical cancer screening and type 2 diabetes management as examples of high-value alternatives. Both represent interventions that can affect health before patients reach more advanced disease, making them different from a strategy focused exclusively on treating complications after they occur.

The modeled coverage-gap reductions illustrate the opportunity-cost principle particularly well. A resource that produces little additional benefit when spent on unnecessary testing may produce considerably more benefit if used to reach someone who is not receiving an effective preventive or chronic-disease intervention.

But the model does not prove that these two areas should receive every dollar released from disinvestment. They are the study’s selected “best buys” for demonstrating the potential opportunity cost. Actual policy decisions would require a broader assessment of priorities, equity, feasibility, clinical capacity and population needs.

What the Findings Mean for Patients

For patients, the central message is not that fewer medical services are necessarily better. It is that more medical care is not always better care. A test that does not improve diagnosis or treatment can expose patients to costs, follow-up procedures and anxiety without delivering a meaningful health benefit.

Conversely, redirecting resources toward effective prevention and chronic-disease management can improve the value patients receive from the health system. That is the theory the study tests. Whether it works in practice depends on implementation, clinical judgment and the ability of Dominican institutions to track both savings and health outcomes.

What the Study Means for Health Policy in the Dominican Republic

The research offers a different way of thinking about health financing. Instead of treating higher spending and better health as interchangeable goals, it asks whether existing spending is producing the maximum possible health benefit.

That question is becoming more important as health systems face pressure from population aging, chronic diseases, new medical technologies and rising costs. The Inter-American Development Bank has projected substantial long-term growth in per-capita health spending across Latin America and the Caribbean and has argued that reducing waste can help make limited resources go further.

For the Dominican Republic, the study provides an evidence-based starting point rather than a finished policy. Its potential savings are meaningful enough to merit attention, but they are not guaranteed revenues. The real test would be whether the country can identify low-value care accurately, reduce it without harming patients and then ensure that the resources released are reinvested where they generate greater health benefits.

Frequently Asked Questions

What is health care disinvestment?

Health care disinvestment is the reduction or removal of funding for a health technology, procedure or use of a technology that provides little or no value in a defined clinical context, with the aim of redirecting resources toward more effective care. It is not synonymous with across-the-board budget cuts.

How much could the Dominican Republic save through disinvestment?

The study estimates potential savings ranging from $122,113 to $8.6 million across the six candidate technologies it analyzed. These are modeled estimates, not savings already achieved.

Which Dominican health technologies were identified as potentially wasteful?

The research program explicitly identifies potentially unnecessary mammography among women under 50 and preoperative chest X-rays for low-risk patients. The study evaluates six candidate technologies overall, but its publicly accessible abstract does not enumerate all six individually. The remaining technologies should therefore not be inferred from the separate Colombia study.

Does the study say mammograms are unnecessary for women under 50?

No. It estimates that up to 96% of mammograms in women under 50 in the analyzed data could be considered unnecessary under the study’s criteria. That does not apply to every woman under 50, and it does not eliminate mammography when there is a clinical indication or elevated risk.

Does the study recommend eliminating preoperative chest X-rays?

No. It identifies potentially unnecessary use among low-risk surgical patients. A chest X-ray can remain appropriate when the patient’s clinical circumstances justify it.

Where could the potential savings be redirected?

The study models reinvestment in cervical cancer screening and type 2 diabetes management. Depending on the technology and scenario, the authors estimate that such reallocations could reduce coverage gaps by up to 1.88 percentage points for cervical cancer screening and 4.08 percentage points for type 2 diabetes management.

Are the estimated savings already available to the Dominican health system?

No. They are estimates produced by an economic model. Real savings would require changes in clinical practice, payment or coverage policies and successful implementation of the proposed reductions in low-value use.

The Bigger Lesson: Spend Better Before Simply Spending More

The Dominican study does not argue that the country should spend less on health. Its argument is more precise: some existing spending may produce too little health value, and identifying that waste could create an opportunity to finance services that matter more.

The distinction is important because the Dominican health system already operates through multiple institutions and financing mechanisms. SISALRIL regulates the health insurance framework, SeNaSa manages health insurance for its affiliated populations, the Ministry of Public Health carries broad public-health responsibilities, and the national budget finances a wide range of health programs and institutions.

The study’s potential savings therefore should not be treated as a simple budget-cutting target. They are better understood as a signal that the country could potentially obtain more health from the money it already spends. The next step is evidence-based implementation: determine which uses truly add little value, protect clinically appropriate care, measure the effects and ensure that resources released from low-value services reach interventions capable of producing greater health gains.

That is ultimately why the study deserves attention. Its headline numbers are estimates, not cash in hand. But the underlying question is real and enduring: when health resources are limited, the cost of a low-value service is not only what it costs to provide it. It is also what the same resources could have achieved somewhere else in the health system.

Primary scientific source: ScienceDirect — Disinvestment and Health Spending Efficiency in Latin America and the Caribbean: A Case Study of the Dominican Republic.

PubMed record: PubMed — PMID 41734648.

Institutional context: SISALRIL, SeNaSa, Dominican Ministry of Public Health, and DIGEPRES.