The Superintendent of Health and Labor Risks (Sisalril), Pedro Luis Castellanos said on the La Cuestión radio talk show that particular interests are delaying the start of the Primary Care for all Dominicans. Castellanos made the remark after local media had emphasized there is no money to pay for the nationwide implementation of primary care.
Castellanos spoke optimistically that an agreement for primary care can be reached in the not distant future. He pointed to the plus of the agreement calling it a step forward. He said private clinics, physician and health providers reached a consensus for the health plan insurance coverage of 36 new medical procedures, equipment coverage for patients, increases in plan coverage for clinics and physicians. The measure applies immediately to those paying into the insurance plans, but those with government Senasa health plans will have to wait six months for the new coverage to start.
The government had proposed Primary Care start with those who pay into their health plan, but this has been rejected by the Dominican Medical Guild (CMD) and private clinic owners. These say the plan should start with the Senasa plan beneficiaries that do not pay into the system that is with the government-subsidized health plan. Likewise, there is concern among private clinic owners and physicians that the primary care scheme will mean fewer patients and fewer revenues for them.
Despite the statement by Castellanos, Minister of Labor Winston Santos had told the press that money is an issue for the start of the primary care. He said that the beginning of the primary care for those not paying for the service would cost RD$150 per member, or around RD$600 million per month. He said the government does not have money for this at the moment.
Pedro Luis Castellanos, speaking for Sisalril, says that the main challenges ahead are to include Primary Care coverage in the basic health plan benefits catalogue. Others are to develop a new system for managing high-cost coverage for members, to create a new form for medicines for ambulatory care and to create new modalities for contracting and paying providers.
“These four tasks contribute to reducing family spending, which is a challenge, because in the last ten years the family spending of members of the health plans has doubled in percentage terms and tripled in absolute peso terms,” said Superintendent of Health and Labor Risks.
The president of the health plan insurance companies (ADARS), José Manuel Vargas says that clinics will receive RD$300 more per night hospital room. And the physicians will receive an additional RD$200 per patient consultation. He said there are around eight million affiliates to health plans, with 3.6 million in the government-subsidized health plan and almost 4.4 million in the paid plans.
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CNSS
Diario Libre
El Nacional
31 October 2019