Patients in Puerto Rico die at statistically higher rates from heart attack, heart failure, and pneumonia than those admitted to mainland U.S. hospitals, an analysis of new government data shows. Advocates in Puerto Rico say U.S. health reform should include efforts to bring Medicare and Medicaid payments more in line with U.S. hospitals, partly by removing reimbursement caps in the U.S. territory. Yet their are other healthcare problems in Puerto Rico: The island's several dozen hospitals may lack money for infrastructure, new equipment and more doctors, according to a report by the Puerto Rico Health Care Parity Coalition.