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The false illusion of having a private doctor for 20 euros per month: “If you pay for the menu of the day, you cannot take the menu with you”

This week, the story of Laura, a pregnant woman who discovered days after giving birth that her private insurance did not cover the birth, went viral on social media. The bill would be around €6,000, even though he had been paying €51 a month for four years, he explained. “Livestock.” With the calculator in hand, the accounts are pretty clear: Laura paid a total of €2,448 after she applied to the insurance company Asisa. For public health, this intervention costs slightly more than 3,500 euros.

Laura’s case, despite its specificity, is not unique in Spain. According to the Collegiate Medical Organization, 30% to 40% of private physicians complain that their patients say they don’t know something their policy doesn’t cover. “Some patients really don’t know what they’re signing up for, or when they sign up for insurance, they think they already have a Plan B, but then they’re surprised to find there are co-pays or gaps they didn’t realize. “- explains Jose Luis Alkibar, a member of OMC private medicine. “We have to spend time explaining what their insurance doesn’t cover, as well as face the frustration of feeling like we’re at fault,” he says.

The idea that low-cost policies are on the rise is, at the moment, based on perceptions, both from professionals and from the advertising campaigns of the companies themselves, given the opacity of the sector. From 12, 19 or 28 euros per month, there are policies with limited benefits, which often include an additional payment after a certain number of consultations or for tests such as X-rays or analytical tests, while excluding more complex ones such as MRI or biopsies.

Under these conditions, indirectly the account grows. “The patient doesn’t realize that it will be cheaper to see a specialist without private insurance,” explains Alkibar. Save €20 policy calculation by staying for one year: €240 per year, which can cover half a dozen primary care consultations. And from there, you have to pay extra. For example, Sanitas, which has insurance for 28 euros per month, charges 4 euros for seven to ten consultations; seven euros from 11 to 15; and 10 euros for assistance. It includes emergency assistance by teleservice; Eight euros more. There is a co-payment of 12 euros for diagnostic examinations.

“You’ll never have to pay for it at any clinic. You swipe your Sanitas card and the next month you see it reflected on your premium,” explains the salesperson on the other end of the phone. And this is one of the problems that service providers claim. That is, private clinics. “For a long time, doctors did not care that they paid cheaply for consultation, knowing that a significant percentage would later lead to interventions from which they made money,” explains the representative of the WTO. But now the scenario has changed: unless they have a follow-up and the more valuable medical acts become public, the reports will not come out. “Sometimes patients pay a co-payment of 20 euros and the insurance company pays the doctor 18 euros for the first consultation,” says Alkibari.

Regarding Laura’s case, Assisa explained to this newsroom that “she took out insurance with outpatient coverage and specialty coverage, but it does not cover hospitalization.” “This type of insurance is rented by quite a few young people who don’t plan to use their insurance for hospitalization,” so you have to pay more for “full coverage.”

Report Health System in Transformation. The challenges of private insurance in Spain also indicate “in recent years a growing trend in the health insurance sector, such as the promotion and marketing of health policies with limited coverage at extremely low prices, which has allowed the democratization of the private sector. A health system that has access to more citizens who did not think before on taking private insurance”.

The work was born out of the Complutense University of Madrid and the Emergency Chair of Sustainable and Responsible Health of the Spanish Private Health Alliance (ASPE). One of its managers, Professor Sonia Juarez, explained to that it is a qualitative report for which almost thirty interviews were conducted with professionals in the sector, institutions and companies: from the insurers themselves to private centers. or patient associations.

“We wanted to highlight the problems that exist around private care,” Juarez explains. And one of them is clear: “People buy health insurance thinking they’re already entitled to full coverage.” “There’s little transparency in policies, the language is complicated and not well understood, and the patient is under contract because they have an emergency or see an opportunity for someone to do well,” he elaborates. When asked what would be the approximate price at which a consumer might expect coverage to be completed, the expert answered the question, “How much does public health care cost?”

The average investment in Spain is about 1,809 euros per inhabitant. In the Idis Foundation’s Private Health, 2023 value creation report, which aggregates the sector, there were 10.3 million insured people in Spain in 2022, not counting civil servants who apply for private insurance paid for by public administrations. , who pay, on average, an estimated amount of 599 euros per year. It is about 50 euros per month. “Today, with a grace period and with the exception of certain previous illnesses, a young person gets a private policy for 60 or 70 euros, which covers everything,” explains the president of the organization, Juan Abarca.

Abarca, who is also president of HM Hospitales, admits that recently there have been insurance policies that cover fewer benefits, “but are as reputable as others.” Although he explains that they do not know what percentage of the increase in policies is due to these “more or less limited” insurances, he indicates that he perceived an increase in the frequency of classic users in his centers, which previously combined private and public health care and an increase in insured

“Now, because they have more problems accessing the public, they are more likely to use the private,” explains Abarca, who points out that the main reason for the increased pressure on health care is the main reason. The wait to access a primary care consultation has doubled in the past four years, and in some communities the average rate has skyrocketed. According to the Health Barometer of the Ministry of Health, citizens in Catalonia report that they wait 11.6 days when they request an appointment before seeing their doctor or family doctor. In the community of Valencia there are 10 days, while in the Canary Islands, Andalusia, the Balearic Islands and Madrid they exceed 9, above the average of 8.8.

This situation benefits insurers who already advertise their policies with the lure of public waiting lists or even the ability to always be seen by the same family doctor, which is happening less and less in health centers, but which hurts service providers. “Conceptually, I’m interested in the patient with a full policy, which is why I’m interested in society doing well, I want people to have insurance with all the benefits, not that when they have something difficult, they go to the social safety net,” Abarca asserts.

This manager is kinder to insurers: “Every policyholder has a part of the responsibility in the insurance they take out. It’s not like a mortgage that you have to get from Harvard economics. It’s completely understandable, but it’s normal if you have an illness, look at the insurance, you can’t blame the insurance and you can’t blame the hospitals , which the citizen himself is responsible for”.

Dr. Alkibari cites an example to clarify doubts: “If you pay 20 euros a month, what do you expect? If you pay for the menu of the day, you cannot take the menu with you.”

Source: El Diario





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