The revision of the agreed regime table and the increase in prices to be paid to private health providers was “inevitable” and “urgent”, justifies ADSE in the newsletter March sent to beneficiaries, explaining the reasons that led to the reformulation of the table that came into force on March 1st.
“The operated review proved to be inevitable and urgent, given the growing and successive increases in health goods and services. But not only. If, on the one hand, beneficiaries reported to ADSE difficulties and impediments in accessing health care; on the other hand, providers complained about the amounts paid by ADSE for certain medical acts, as they were below the prices practiced in the current context of inflation and did not cover their real costs”, underlines the board of directors of the institute that manages the disease protection system of state workers and retirees.
In response to criticism from unions and beneficiary associations, ADSE adds that some medical acts “were being removed from the conventions and billed to beneficiaries on a free basis”, which “caused enormous instability and discontent among beneficiaries”.
In view of this situation, “ADSE had to intervene, revising the price list across the board by 5% and in higher percentages in the areas of radiology (X-ray, CAT scan, magnetic resonance imaging, ultrasound scans, etc.), surgery (area of urology, gynecology and ENT) and certain specialty consultations (pediatrics, oncology, gynecology, obstetrics, psychiatry, rheumatology and dermato-venereology).
The purpose of this review, he adds, is to allow beneficiaries to “find more easily the agreed medical services they need, with the required quality and more consistent with current practices, so that they do not feel limited, or even discriminated against in the access to private providers”.
ADSE guarantees that 90% of consultations did not have any increase either for ADSE or for beneficiaries. But it confirms that six specialties saw the price paid by beneficiaries increase from five to 7.6 euros (52% more), namely psychiatry consultation, child and adolescent psychiatry, rheumatology, obstetrics, gynecology and dermato-venereology.
The pediatric consultation went from seven to nine euros, which represents an increase of 28.6% for beneficiaries, and the multidisciplinary oncology consultation, had an increase of more than 60% and now costs 32.42 euros.
In the case of medical exams, ADSE took the example of radiology to conclude that, of the 211 exams foreseen in the table, 53 did not have increases, 126 saw their price increased between one and 1.94 euros and 32 had an increase between two and five euros.
“It appears, therefore, that only 15% of the total number of exams suffered increases of more than 1.94 euros”, concludes the ADSE.
In percentage terms, the beneficiaries’ charges have risen significantly. As PÚBLICO had advanced, following the analysis it made of the tables, the total price of a breast ultrasound, for example, rose 134.5%, with the beneficiary paying 6.80 euros, instead of 2.90 euros .
A cervical X-ray now costs 125% more and a mammogram has increased by 48%.
Overall, the new table of the agreed regime brings an increase in ADSE charges of around 27 million euros per year, while beneficiaries see costs rise by 7.7 million euros.
In the opinion approved this Monday, the General and Supervisory Board of ADSE argues that the system should pay the entire price increase with the agreed regime, without burdening the beneficiaries.