In a step back in market freedom in private medicine, the Government announced its decision to establish limits for fee increases, and did so through a measure that implies a significant reduction in the increases that members pay up to this month.
Javier Milei's management ordered seven prepaid companies - Galeno, Hospital Británico, Hospital Alemán, Medifé, Swiss Medical, Omint and OSDE - to roll back the fees to the value of what they charged in December and to recalculate the cost adjusting it for inflation.
On the side of the doctors, who days before from different unions and associations denounced that their salaries did not grow to the scale of what the prepaid and social works increased to the members, now they speak of a
collateral effect of the official reversal
. One that, ultimately, could affect patients. And what is the problem of collecting co-payments.
The brake will also be on increases for health professionals, as sources in the sector confirmed to this newspaper, as a result of not being able to increase the cost of having one coverage or another “at ease.”
They assure that the consequence will be that
more and more co-payments will have to be paid
to receive care from specialists who appear in the card, and that
the shift towards “individual only” care will deepen
.
“Prepaid payments have increased 140% since December and doctors receive approximately 30% more in our fees. Furthermore, payment is not immediate,
benefits are collected within 30 or 60 days.
There we have again between 10% and 15% loss due to inflation in the gap,” explains Victor Baldassini, an ophthalmologist who is a member of the Board of Directors of the Medical Confederation of the Argentine Republic (COMRA).
Jorge Iapichino, general surgeon and member of that confederation, reaffirms that the average increase nationwide for doctors in 2023 "did not exceed 100%, when inflation was more than double."
The average increase for doctors, from January to now, says Iapichino, “in some cases it was 20% and in others 35%.” What does the difference depend on? “Not on the specialty…it depends on where you practice in Argentina. The country is as if it were several countries,” he compares.
In the south, it pays better per consultation than in the north, among the provinces with lower medical fees, and than in the City of Buenos Aires. “Because there are more doctors and there is more supply of specialists,” he explains.
The private sector, in general, pays between $7,000 and $8,000 per consultation, when the so-called “professional ethical value” (the name with which doctors justified the co-payment or extra charge to members last year) is between $15,000 and $16,000.
“Medical fees increased 236% from March 2023 to March 2024. Obviously, if there are no fee increases (or only by CPI, which is the Consumer Price Index), the situation will continue (there will be no increases 'above ' to professionals). The priority throughout this time was to restore the medical fee and it will be restricted to what the law dictates,” according to
Clarín
in the case of OSDE.
From December to March, this prepaid plan, one of those that pays the best for appearing in the card and also one of the most expensive, “increased its direct providers by 71.88%,” which are the private specialists who serve in their offices and who They have a direct contract with OSDE.
“
It was a pressure cooker
, when the Government allowed increases in prepaid fees without the authorization of the Superintendency of Health Services,
the values skyrocketed
.” These increases accompanied what supplies cost today (the great complaint of prepaid medicine), but they did not coincide with the increases in professional fees,"
Jorge Coronel, COMRA president, tells
Clarín .
In a way, he describes, the new change "is bad news for doctors," because it reinforces "the justification of social security and prepaid insurance companies for not being able to increase what they pay per consultation."
Especially in the south of the country, says Coronel, “some prepaid companies raised their fees by up to 40% since December.” For this reason, he insists, “
the negotiation has to continue
, so that members do not once again bear the cost of what prepaid medicine does not pay to doctors.”
While on the health professionals' side they speak of an average payment only 45 days after the medical consultation, the Argentine Health Union (UAS), on the other hand, assures this newspaper that it is not only recovering the medical salary but even since January “the payment time is being shortened.”
They also confirm that the brake on “tailored” increases, which was a resolution of the Ministry of Commerce based on an opinion from the National Commission for the Defense of Competition (CNDC), will also have an impact on the updating of the Medical fees.
The change of change
The official decision was announced by the presidential spokesperson, Manuel Adorni, and he specified on Wednesday that "by order of the Ministry of Economy, a group of private medicine companies, which represents almost 75% of the affiliates, are going to retrograde the value of their quotas as of December 2023, adjusted by CPI from there on."
In four months, then, the Government went from allowing, by decree of necessity and urgency, total freedom for prepaid and social works to increase their contributions, to imposing limits on increases and even ordering a reduction in the prices of the invoices that arrive today.
At the level of health service benefits that have to do, for example, with the performance of dental treatments, clinical analyzes or imaging studies, it would also lead to the naturalization of requiring an extra charge for each practice, or for the provider decides to suspend care according to a certain prepaid plan.
Technically, the clinics, the clinical analysis and diagnostic imaging centers, are the
legal providers
, who hire their specialists and who have their own agreements between them, which makes it even more difficult to speak of generalities regarding what percentage of the increase in the membership fees came to pay the doctors.
P.S.