Nobody gives hard four pesetas. If you think that by taking out private health insurance for a premium of nine euros a month, like the ones being advertised, your access to medical care will improve, it is because a) you have not understood the meaning of the saying or b) your generation does not has known the pesetas. The knockdown rates – “More coverage for less price”, “The cheapest health insurance”, “Offers, promotions and discounts on health insurance” are some slogans – lead to a knockdown return. Insurers have decided to compete on prices in a rapidly expanding market due to the difficulties of access to public health, at the cost of sacrificing the quality of care and the salaries of professionals.
“Two years ago I left a company because the working conditions were shameful, with very low salaries and enormous limitations, such as being able to visit a patient once every two months at the most,” explains Pere Torner, head of the professionals section. Free insurance from the Col·legi de Metges in Barcelona. “Many colleagues have left some entities because they consider that the conditions are humiliating. It’s a shame, because there are patients who have been there for 20 or 25 years, and it is also a sector that brings enormous economic benefits to companies, ”he deepens.
When they talk about humiliating conditions, the doctors refer, for example, to charging 40 euros for a surgical intervention, to be distributed among the entire team, made up of a minimum of three people: surgeon, instrumentalist and assistant. When they refer to shameful fees, they allude, among other things, to getting up at three in the morning to go to a clinic to attend to an emergency such as a broken bone. Take an X-ray, reduce the fracture, place the plaster, wait, control X-ray… Total, a couple of hours to pay between 20 or 30 euros.
The Consell de Col·legis de Metges de Catalunya exhorts to “put an end to the situation of increasing deterioration that exists in the private health sector linked to free insurance”. “The unbridled proliferation of policies, often unworthy, generates more and more defenselessness and vulnerability among citizens, and favors the precariousness of many professionals who work for insurance companies,” the associations state in a letter to the Minister of Health of the Generalitat. They demand that Manuel Balcells establish a regulatory framework and the “regulation of the sector”.
The number of private policies is growing non-stop, also encouraged by the effects of the pandemic on the public system. In Catalonia, 34% of the population has private coverage and in Barcelona city, 40%. In this situation, the medical associations demand regulation, so that the insurers give detailed information about the coverage they offer. “They have been in an economic war for a few years offering low-cost policies, with offers of 16 euros, and 20 for the whole family. It is evident that with these quotas it is not possible to offer correct health coverage”, warns Torner. Another problem is that some companies raise prices disproportionately as the client gets older until expelling him when the pension is no longer enough. “Salut would also have to put order in this: limit the increases based on the time that the client has been insured.”
The increase in policies translates into greater care pressure in private centers. Although accessibility continues to be the great claim of the private sector, some delays in specialties are beginning to occur. At this rate, the private crisis will be greater than the public one, warns a doctor. The ophthalmologist Joan Carles Raiteri exposes the difficulties to incorporate the numerous technological advances while charging very low fees. “It must be said that not all entities are the same,” he says. There are those that do bet on new diagnostic methods and new treatments”.
In the opinion of this doctor, the situation is terrible and the Administration, “always thinking about electoral issues”, turns a deaf ear. “I know of colleagues who have left mutuals because it didn’t pay off, what you can’t do is lose money,” he says. However, he considers that the dynamics of deterioration will come to an end in about two years. First of all, because the Administration must be aware that private healthcare is also a public service and guarantees the viability of the public system. Secondly, because “companies also need good professionals with advanced means”.
Ignacio Orce, president of Assistència Sanitària, an insurer with a team of 5,000 doctors and owned by a company of physicians, is more pessimistic. “Companies want to make money and have discovered that the factor that makes the business more expensive is the doctor. Thus, they make them work in frankly unworthy conditions and prices. Take it or leave it; if you want to work, you have to adapt.”
The market is riding on a downward price struggle and for shareholders to earn money to the detriment of professionals, according to Orce. In his opinion, regulation in a free market system is “utopian” and the health crisis is here to stay: “The public is underfinanced – in Catalonia it would require 5,000 million more a year – and the contributing role of the private sector is not it is recognized.”
