Nobody gives a damn about four pesetas. If you think that by taking out private health insurance for a premium of nine euros a month, such as those currently advertised, your access to medical care will experience an improvement, you either a) have not understood the meaning of the saying or b) your generation has not known pesetas. The hyped rates – “More coverage for less price”, “the cheapest health insurance”, “Offers, promotions and discounts on health insurance”, are some slogans – also lead to hyped results. Insurance companies have decided to compete on prices in a market that is expanding due to the difficulties of accessing public healthcare, at the cost of sacrificing the quality of care and the remuneration of professionals.
“I left a company two years ago because the working conditions were embarrassing, with very low fees and enormous limitations, such as being able to visit a patient once every two months at most”, explains Pere Torner, head of the section of free insurance professionals from the College of Doctors of Barcelona. “Many colleagues have left some organizations because they consider the conditions to be humiliating. It’s a shame, because there are patients you’ve been seeing for 20 or 25 years, and, in addition, it’s a sector that brings enormous economic benefits to companies”, he elaborates.
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 at least three people: surgeon, instrumentist and assistant. When they refer to outrageous fees, they allude, among other things, to getting up at three in the morning and going to a clinic to attend to an emergency such as a broken bone. X-ray the patient, reduce the fracture, plaster the injury, wait, control X-ray… Total, a couple of hours to admit between 20 and 30 euros.
The General Council of Medical Associations of Catalonia exhorts to “put an end to the growing deterioration in the private health sector linked to free insurance”. “The unrestrained proliferation of policies, often unworthy, generates more and more helplessness and lack of protection among citizens and favors the precariousness of many professionals who work for insurance companies”, affirm the collegial entities in a letter to the Minister of Health of the Generalitat. They demand from Manuel Balcells the establishment of a regulatory framework and the “ordering of the sector”.
The number of private policies is growing without stopping, 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, medical associations demand regulation so that insurance companies offer detailed information about the coverage they offer. “They have been in the middle of an economic war for a few years now, offering low-cost policies, with offers of 16 and 20 euros for the whole family. It is clear that with these quotas it is not possible to offer correct health coverage”, warns Dr. Torner. Another problem is that some companies raise prices excessively as the customer gets older, to the point of kicking them out when their pension is not enough. “Salut should also put this in order: limit increases according to the length of time the client has been insured.”
Although accessibility continues to be the great claim of the private sector, there are beginning to be some delays in specialties. At this stage, the private crisis will be greater than the public one, predicts a doctor. Ophthalmologist Joan Carles Raiteri explains the difficulties of incorporating the numerous technological advances by charging minimal fees. “It must be said that not all entities are the same,” he said. There are those who do bet on new diagnostic methods and new treatments”.
According to this doctor, the situation is terrible and the Administration, “always thinking about electoral issues”, ignores it. “I know of colleagues who have left mutual funds because it didn’t work out for them, what you can’t do is lose money,” he says. However, he believes that the dynamic 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 insurance company with a cadre of 5,000 doctors and which is owned by a company of doctors, is more pessimistic. “Companies want to make money and have discovered that the factor that makes business more expensive is the doctor. So, they make them work in frankly unworthy conditions and prices. Either you accept it or you let it go; if you want to work there, you have to adapt.”
In his opinion, regulation in a free market system is “utopian” and the health crisis is here to stay: “The public sector is underfunded – in Catalonia it would require 5,000 million more a year – and it is not recognizes the co-adjuvant role of the private sector”.
