The delivery of adult diapers is restricted.
Dentists decided a long time ago to suspend service to members.
Clinics begin to
cut off patient care
.
And medication coverage – on average – is 20% of the retail amount.
That is the short list of inconveniences that the coverage of the Medical Assistance Work Institute (IOMA) has and that led to protests – some with incidents – in different parts of the Province.
The conflict expands over a universe of
2.3 million people
.
It is the number of affiliates to the social work of Buenos Aires public employees and their families.
The entity is suffering from financial asphyxiation recognized by the authorities that impacts the service.
Just some examples: in Mar del Plata (there are more than 120 thousand members) three of the five most relevant clinics in the district
decided to suspend
care for IOMA.
Two months ago, the Medical Federation of the Province of Buenos Aires (Femeba) threatened to cut off services to members of La Plata, Ensenada, Tandil, San Pedro and Mar del Plata.
He reported that the organization owed payment for consultations of almost 2.6 billion pesos.
The Platense Society of Anesthesiology (SPA)
suspended scheduled surgeries
in health institutes between the 17th and 27th of this month.
It's like a tombola: each patient must find out what day it will be their turn to go to the operating room.
It is because the professionals could not agree on fees that were at November values, as they said.
IOMA hires intermediaries – such as FEMEBA, medical associations or professional associations – to make health practices viable.
Some, such as kinesiologists, anesthesiologists or dentists, decided – in the face of complaints and delays – to suspend care at certain times.
They are fighting fronts that open and hit the members.
Protest in front of the IOMA headquarters in Tandil.
Photo: X
The Dental Federation of the Province of Buenos Aires (FOPBA)
closed its offices to members
in December and January.
In both cases due to delays of several months in the payment of fees for September and October 2023. Also in protest against "increases that were authorized by the IOMA board of directors in March and April 2023 and have not yet been made effective."
Although there were partial payments, the situation remains in conflict.
It is a chain of inconveniences with an impact on professionals.
For example: kinesiologists receive
1,800 pesos per session
;
Doctors charge between 2,700 and 5,500 pesos per consultation (depending on the category), according to data from November 2023. After that there was an adjustment of just over 17% in December and a 25% improvement is pending in January , but
it is still for the board's signature
and must go through the provincial control bodies.
It may take three months.
The delivery system determines that the mutual insurance company pays a fixed amount as coverage for medications in pharmacies.
With the devaluation and the spike in drug prices (more than 120% in December and January) the discount remained at the
average 20%
, as recognized by the president of IOMA, Homero Giles, in a report he offered in the Legislature.
It is the average, but there are cases with less help.
Some examples: Optamox (amoxicillin) duo 1g x 14 tablets costs 17,324.50 pesos and with the IOMA prescription the member pays 15,650 (10% discount).
Until three months ago, there were products with 100% coverage such as bisoprolol, which is used for any cardiac pathology.
Now it has coverage of
between 20% and 50%
.
Specific cases: Corbis (bisoprolol) 5mg x 30 tablets 11,296 pesos (IOMA covers 52%);
Lotrial (Enalapril / Hydrochlorothiazide) 10 mg x 50 tablets 11,199 pesos (IOMA covers 50%) or Alpertran (Antihypertensive) 160mg x 28 tablets 23,591 pesos, (IOMA covers 19%).
The president of IOMA met with representatives of the blocks of the Chamber of Deputies of the province of Buenos Aires.
Other problems
are repeated in social media forums and informal complaint channels
.
“The doctor prescribed 120 diapers for my father and the social insurance only covers 40. I had to pay for the rest,” wrote a user on the “Amparos, denuncias y claims” site on Facebook.
Appeals to Justice are an alternative to the lack of coverage for special medications or highly complex treatments.
At IOMA they said that there are drugs for these diseases that have a value of up to
200 million pesos
.
Provincial deputy Claudio Frangul (UCR-GEN Civic Agreement bloc) requested that the
percentage coverage system
be resumed .
He presented a bill to impose an annual and permanent audit on provincial social work.
And he demanded to guarantee “that the funds owed to IOMA are administered by IOMA and not by the Buenos Aires Government.”
That is one of the axes of the financial crisis of the lending organization.
According to what the opposition proposes, the discounts for employees and the State contribution reach the Provincial coffers.
And the IOMA must ask that money be sent to it.
It is not administered by social work.
The budget that the provincial Legislature approved last year for the IOMA was $362,442 million.
This year no new law was passed, therefore that amount will be extended and adjusted.
The protest of IOMA affiliates at the La Plata headquarters, this Wednesday.
Photo:Infocielo
Giles attributes the current explosion to the political context: "The social work was growing, organizing its financial issues, expanding coverage, but there is no doubt that
the shock that occurred from October to December 2023
economically, in which the market increased prices, put us in a very difficult situation," he said.
It exhibits as a sample of the “recovery”: last year they launched “telemedicine” (60 thousand monthly consultations);
125 polyclinics were opened (where members can go for free);
2.4 million medications were delivered to 40,000 100% affiliates;
31 clinics were set up for care and the “100 See You Better” program was launched, which delivered 25,000 glasses (this is now behind schedule, according to reports on the networks).
The president of IOMA is a 42-year-old doctor, graduated in Cuba, who worked in the last stretch of the second government of Cristina Fernández (2011-2015) in the Ministry of Health.
He came to the institute because of his relationship with Minister Nicolás Kreplak.
Both made up the teams of the La Cámpora health area.
He also held the national government responsible for the
impact of the devaluation
on the health system, the total liberalization of prices and services and the adjustment towards the province of Buenos Aires.
Until December, Axel Kicillof received an extraordinary contribution for health sent by the National government.
Now that has been reduced to 0, they say in the Government.
“IOMA buys benefits, it does not manufacture medicines, prostheses, it has hospitals.
The price at which you buy is determined by the healthcare business market.
Therein lies the difficulty.
In recent months and in the face of these new rules, the quality of benefits has decreased because it is impossible to sustain those 100% coverage levels that we had,” they argued close to the president.
Regarding the Mar del Plata clinics, Giles explained that those sanatoriums
decided to unilaterally break
the agreement with IOMA.
"It's not a question of we owe them because we don't have debt," he said.
The cracks in the system are widespread and reach other providers.
15 days ago, the Association of Transporters of People with Disabilities denounced that the social work is "180 days behind in payments."
Another complaint: the fees for Occupational Therapy;
Rehabilitation;
Direct Rehabilitation Clinics;
Special Education (Therapeutic Institutions and Communities) had an improvement of 15% as of December 1, 2023, compared to the values of December 2022. “In the same period of time, the INDEC registered a 211.4% index general in the twelve months of 2023”, the providers stated.
IOMA is,
after PAMI
, the largest health provider in the country.
In the midst of the changes proposed by Javier Milei's libertarian administration, its operation is under scrutiny.
“They want to impose the end of a solidarity and broad coverage system.
There are many interested in
the institute collapsing
,” they maintain in the provincial government.
Kicillof has decided that he is not going to adhere to the “free choice” regime that Milei promotes.
IOMA receives – on average – 25 thousand pesos for each employee who is obliged to contribute.
They are teachers, administrative agents, police and municipal officials who have no choice.
Nor would they have better coverage in the private system with that monthly contribution.
The Silver. Correspondence
P.S.