Study sees drop of up to 60% in medical fees due to end of Isapres and free choice modality

Up to 61% could drop the income of doctors if the elimination of the Isapres and the end of the free choice modality of Fonasa that contemplates the reforms to the health system derived from the constituent process and that coincides with the government program of the current administration.

The number comes from the study on the subject carried out by the Public Health Institute of the Andrés Bello University (UNAB) and edited by the entity’s director, Héctor Sánchez, and the entity’s adjunct professor, Manuel Inostroza.

The forecast scenario assumes that at some point the country will move towards a single health fund, which would be accompanied by the disappearance of the Isapres as they are known today -where the majority of people decide where and how to receive care-; and, in the public sector, the end of the free care modality, in which the beneficiary freely chooses the professional and/or entity, from the public or private sector, that is registered in the role of Fonasa.

As a starting point, health-related professionals point out that Chile has made a “significant effort” to increase health spending as a percentage of GDP – which has grown from 6.8% to 9.4% between 2010 and 2020 -, which has made it possible for people able to access private providers to reach 15.5 million.

For the same reasons, the health sector today has more doctors: 59,513 this year, of which 22,029 (37%) are in the public hospital system (SNSS); 5,013 (8.4%) in primary care (PHC) and 32,471 (54.6%) in other institutions.

In fact, they affirm that in the last 15 years, doctors at the national level have increased by 29,517 and their increase has been 108% in the SNSS, 109% in APS and 91% in other institutions.

The stages

For the analysis, Sánchez and Inostroza focused on variable medical income, without taking into consideration changes in fixed or contracted income, both in the public and private spheres.

Three scenarios are proposed.

The first, called zero, in which the income of doctors is what they currently receive for benefits provided in the private sector to beneficiaries of the Isapres and groups B, C and D of Fonasa that use free choice .

In this case, the medical income for the selected benefit groups could range from $29.07 million to $45.37 million annually for each of the physicians.

What would happen in scenario 1? This situation, which assumes that there are no Isapres and only complementary insurance, despite the fact that only 50% of former Isapre beneficiaries (for reasons of age, pre-existing conditions and economic capacity) can have access to complementary insurance, the income from the baseline situation could be reduced by 35%.

In scenario 2, in which Fonasa in the short or medium term eliminates the possibility of attending private providers through free choice and, therefore, only group D beneficiaries have access to complementary insurance, the lowering of fees doctors would be up to 61%.

Sánchez considers it “important” to put these figures on the table so that when the proposals that the government wants to send to parliament are analyzed, all dimensions are evaluated, not just the final objective of creating a single health insurance, “which has significant costs. for people, doctors and health service providers in the public and private sectors”.

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