Private clinics and their physicians in the north central regions of the DR went on strike today protesting what they consider unfair contractual conditions with medical insurance plans. The Dominican Medical Association has joined the Association of Dominican Clinics (Andeclip) in their plight to get better conditions from medical insurance companies for clinics and physicians serving those on medical insurance plans. The system has worked well for the consumer, but now the medical establishment feels they are not getting a fair share in the business. In the DR an estimated 1.5 million Dominicans (mostly employees) benefit from the medical plans that provide high cost medical services to Dominicans at very reduced prices. It is estimated that 80% of the patients attending private clinics are on some kind of medical insurance plan. Some 225 clinics are affiliated, and some 8,000 physicians. Yesterday, 80 member physicians of the Dominican Society of Neurology said they are resigning from their contracts with medical insurance companies in protest for the low fees paid for their services. This was the first association of specialists to cancel their contracts with the medical insurers. The clinics and physicians gripes: The medical insurance companies are making a 50% profit. The medical insurance companies delay up to 90 days in making payments for their services, despite getting paid in advance by affiliated companies or individuals (individuals need to pay an entire year in advance). Physicians are paid RD$60-RD$160 for seeing a patient and RD$100-RD$300/day for seeing a patient that is hospitalized. Physicians charge their private patients five to ten times that amount. Insurance companies do not differentiate when paying a specialist or a generalist. Contracts prohibit them from charging insured patients more than minimal difference (about RD$20). Insurance companies make the same per service payments regardless of the equipment and facilities offered by the clinic. Medical insurance companies position: The medical insurance companies gathered under the Cámara Dominicana de Aseguradores (CADOAR) say they have signed contracts individually with the clinics and physicians. They say they will only negotiate on an individual basis with clinics and physicians. They say that they provide volume for the clinics and physicians, and thus the reduced price for the service. They have said they will cancel the contracts with clinics or physicians that unilaterally do not respect the clauses.
