Social Security and Insured Patients: Understanding the Differentiation and Additional Costs

2023-08-15 05:38:50

The story of how social security deals with insured people and illnesses is similar to the story of a jug of oil. In the “principality” of social security, “people are obese and people are oily,” as the popular proverb says… Why do we say that? Because the use of the guarantee with patients occurs according to classifications, and there are patients with degrees, for example, a dialysis patient is considered a first degree, and he is paid a dollar according to the price of an exchange platform or 80 thousand pounds, while a cancer patient is a lower degree, as he still gets from the guarantee The price of the medicine is 1,515 pounds, while he pays it at the exchange rate of the dollar on the black market.

The Director General of Social Security, Muhammad Karaki, agreed to follow the Ministry of Health in its decision No. 1/332 dated 04/05/2023, related to amending the tariff for the dialysis session and amending the doctor’s tariff, so that the hospital’s share became $53 or 5,240,000 L.L. And the doctor’s fees are $10 or 1,040,000 LBP. to…

differentiate between patients

In this matter, Karaki did it and followed the example of the Ministry of Health, so that the cost of 1,400 patients amounted to 1,727 billion pounds, while the cost of medical treatment amounted to 1,400,000 Lebanese, benefiting from insurance, 350 billion pounds, according to the calculation of the results of the Sickness and Maternity Insurance Fund until 05/31/2023 A copy of which Al-Nashra obtained and presented in a previous report… Isn’t this considered “obese people and oily people”? So why is a cancer patient whose failure to take the medicine leads to a deterioration in his health and possibly his death, is deprived of what is given to a patient who is doing dialysis, knowing that there is a surplus in the guarantee fund that amounted to 672 billion pounds!

Returning to dialysis patients, hospital tariffs for dialysis sessions were raised to 6,280,000 pounds, including the doctor’s fees, and it was found that the cost of one patient undergoing the sessions amounted, according to informed sources, to one billion, two hundred and thirty-three million pounds, noting at the same time He pointed out that “the cost spent on treating 1,400 patients to hospitals is five times greater than the treatment of all those covered by the guarantee.”

additional costs

The sources go further to indicate that “despite raising the dialysis tariffs, hospitals bear additional costs for patients, and the reason is due to the lack of agreement between Social Security and hospitals on the cost, as it is clear that the guarantee has raised the tariffs, but hospitals do not abide by them.”

Further, the doctor’s fees were raised to one million and forty thousand pounds. Here, the sources indicate that “there is more than one patient in the dialysis room, and the number may reach more than ten people. Is it reasonable that the doctor in one round of his gets more than ten million for the ten patients he passed?”

Who is watching?

The sources ask about the schedules of dialysis patients sent from hospitals, as any of them, according to the sources, can “come and say there are 30 patients who underwent four dialysis sessions for a certain period, and the guarantee is to cover the tariff and the doctor’s fees,” while the question here is: “Who monitors and who adjust this process?

Despite everything we have mentioned, the goal is not to correct what dialysis patients get from Social Security, because this is one of their rights as it is the right of the rest of the Lebanese to obtain medical care, but the question is “Why does Social Security charge a cancer patient 1,500 pounds?” For example, if he bought a drug that cost $400 in the past, 60,000 pounds would be returned to him, and today, after the dollar exchange rate has risen, the value of the same amount in green currency has become equivalent to 35,600,000 pounds. to. Social Security refunds him 60,000 pounds, with a reminder of the aforementioned surplus…

What right does he make this distinction between patients? Why not resort to the application of Law No. 3685, which talks about the rates of contribution to the costs of medical care and hospitalization cases by the insured and the National Social Security Fund, with 90% borne by the Fund in cases of hospitalization, 80% in all types of medical care costs, 10% The contribution of the insured in hospitalizations and 20% in all types of medical care costs, and therefore the insured recovers 80% of the value of the drug, while he currently recovers 1.34% of its value, including cancer patients?!

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