2023-10-04 03:01:00
Since Monday, a system of “de facto co-payments” has been in force throughout the country, which prepaid and social work doctors will charge their patients to complement what they consider the “minimum ethical fee,” set at 6 thousand pesos per consultation. In the province of Buenos Aires, consumer associations denounce medical entities and prepaid medicine companies for violating the competition law. The lawsuit was filed in the courts of Lanús.
“Due to the innumerable complaints received, our Association learned that the majority of the chambers that bring together doctors in their different specialties decided to agree and set a minimum medical fee, higher than the amount they receive from prepaid medicine companies and oblige the users and consumers to pay it (copayment), a situation that, in addition to being harmful, confronts them directly with the prepaid medicine companies that do not cover the medical fees claimed by these Chambers,” says the opening paragraph of the statement distributed by the Association. of Defense of Users and Consumers (ADDUC), headed by lawyer Osvaldo Bassano.
“This situation, in addition to harming consumers, implies price fixing prohibited by the Competition Law. That is why our Association on 10/2/2023 filed a complaint with the Competition Defense Commission to proceed with the investigation provided for by law 27442 on the situation of cartelization of the price of the medical fee. For this reason, considering the unrestricted defense of the human rights of consumers, ADDUC proceeded to request the instruction of an investigation summary to the National Authority, without prejudice to continuing to act in defense of the users of the system,” he concludes.
In the province of Buenos Aires, the Medical College had implemented a bonus for “office expenses”, which even charged beneficiaries of the Comprehensive Medical Care Program (PAMI) and the Provincial Medical Assistance Work Institute (IOMA), until two weeks ago, when they decided to terminate it due to pressure from the provincial government.
In this regard, in radio statements, the Minister of Health, Nicolás Kreplak, maintained that co-payment “is a terrible idea because it creates an access barrier” and was emphatic in stating that health “is not a market or a business and the State must regulate it”, but in this case “it is a responsibility of the Health Services Department of the national government.” He added that, in these years, “IOMA reduced the co-payment collection by 80 percent.”
Dodgy accounting
In its recent history, ADDUC has one significant victory. At the beginning of this year, he managed to get prepaid medicine companies to return to users the updated amount corresponding to a poorly settled increase in 2012. The total amount of the demand exceeded 2 billion pesos.
“In that case, some companies paid and others did not: some even claimed that they did not have the corresponding documentation,” says Bassano. “It is very difficult to access the companies’ balance sheets: if they lost money, as they say, they would show them openly,” adds the lawyer who also states that “thanks to the fact that they hide or draw balance sheets, with the passivity of the Superintendency of Health Services, they can financially suffocate the clinics and with that money buy properties, television channels or directly form external assets.”
Among his objectives, Bassano hopes that the Ministry of Internal Trade will call for the formation of the Price Observatory. “It is provided for in the law, but it has not happened yet,” says the lawyer, for whom it is clear that “there is abusive financial pressure from companies on professionals.” The problem, he says, is that this pressure should not be unloaded on the users, who already pay their dues with effort. In their vision, the issue should be resolved “by facing who it belongs to.”
short blanket
The tension between providers (clinics, sanatoriums, laboratories and private doctors) and financiers (prepaid medicine companies and social works) has always existed, in the same way that occurs between the different links of any value or production chain. The news is that the conflict has worsened since the pandemic emerged. Sources from the sector usually affirm that the problem is that they have “freed costs and depressed income”, in reference to the fact that fee increases require prior government authorization and the benefits that they must offer in exchange tend to be increasingly more, often included via judicial.
The other fact that the sector comments quietly as an explanation is the growing voracity of laboratories, particularly foreign ones, that manufacture some drugs and treatments for so-called “low prevalence diseases,” previously known as “rare diseases.”
According to the Argentine Health Union (UAS), an entity chaired by the head of Swiss Medical, Claudio Belocopitt, “in the cost structure of any social or prepaid work, spending on medicines was around 15 percent five years ago, today it is already exceeds 30, in some cases it exceeds 40 and nothing indicates that it is going to stop on its own.” “The price of medications increased, new very expensive medications appeared, and the rate of use of these medications also increased,” it is added. .
The companies’ demand in this regard is the creation of a “health technology evaluation agency”, a model that exists in countries such as France, the United Kingdom, Brazil or Israel. It is a scientific committee, whose opinions are binding, and consider both the scientific impact of each innovation and the financial impact, from a systemic perspective. There are at least half a dozen projects in this regard in Congress, but their legislative process is slow.
Another frequent complaint from professionals, in a context of high inflation, has to do with payment terms. These are such large volumes of money that a delay in payment of a few days can make a huge difference. In her recent presentation at UMET, Vice President Cristina Fernández de Kirchner urged prepaid companies to stop doing financial business with the resources of the system.
Deadlines vary. In some towns in the province, such as Tandil, where the Medical Circle responds to the interests of Mayor Miguel Lunghi, they pressured until IOMA paid in 5 days. The next fastest is OSDE, which pays 30. The rest take 60 or even more.
The theme that is also repeated and that underlies each of the proposals is that health care collects in pesos, but a good part of its expenses are dollarized. Consequently, costs in dollars put pressure on costs in pesos, such as medical fees and salaries of administrative and paramedical personnel. What according to Bassano does not suffer is business profitability.
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