2023-10-02 13:55:21
The financing crisis of the private medicine system today adds a new problem for patients (Getty)
With the beginning of the month of October, the “minimum ethical medical fee” came into effect, a type of co-payment promoted by more than 30 medical associations in the country. This new scheme establishes a minimum fee of 6,000 pesos for medical consultations, and any difference between this amount and what the prepaid or social works cover must be assumed by the patient in the form of a “non-refundable complementary bonus.”
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The decision was announced within the framework of Health Day, in a statement where medical groups expressed their concern about the crisis that has brought medical fees “to the lowest level in the history of the country.” According to the associations, the value of medical consultations has experienced a drastic drop in recent years, aggravated by delayed payment of fees and high inflation. The new “minimum ethical medical fee” will be adjustable bimonthly according to the inflation index, they announced.
This is, however, a unilateral measure by associations that bring together professionals and providers. Not a rule that has the endorsement of the entire health system or the Government. Therefore, it is not free from controversy.
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The private health system is organized around financiers – prepaid medicine companies and social works – and providers – professionals, diagnostic and care centers, etc. – which makes the latter depend on the income of the former and the rates charged. established for the payment of each benefit. In the midst of a context that prepaid medicine companies define as “total definancing” and a price freeze on the fees they charge their members that is in effect until the end of October, these “copayments” are an emerging conflict between the parties. .
The providers demand increases in the rates they buy, the financiers limit these increases according to the amounts of fees that the Government allows them to charge and the result is this extra fee that some associations seek to generalize to close the gap between the rates they receive and the march of inflation.
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Prepaid medicine companies have responded cautiously to this measure. They assure that co-payments are not contemplated in the contracts with the doctors and that, in the event that an extra is charged, the patient must inform the prepaid company to initiate a system of refunds and possible sanctions to the doctor who has charged it. Some companies, such as Galeno and Swiss Medical, have confirmed that they will refund upon presentation of the invoice.
The $6,000 per consultation works as a maximum. Where funders grant rate increases, that amount may be reduced. “If what we receive from the system (social works, prepayments, sanatoriums, among others) is less than this amount, the difference will be covered by the patient as a non-refundable complementary bonus,” they noted. So, for example, an increase of $1,000 in a given rate will reduce the co-payment request to $5,000 per visit.
Among the funders, they consider that the initiative, launched by around thirty organizations to which new ones were added until there were around fifty, is not widespread among professionals.
“We will see how the issue progresses today. The associations want to get paid, but not all professionals want to do so,” one of them confided to Infobae.
If a doctor charges extra for the consultation, users must inform their prepaid medicine company. This notice will activate a refund system and could lead to sanctions for the doctor who made the payment. It is important that users are aware of this new measure and know how to proceed if they face additional charges.
The implementation of the “minimum ethical medical fee” marks a turning point in the debate on the financing of health care in Argentina, and its impact will be closely followed by both health professionals and users of the system.
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