The Dominican Medical Association (CMD) nor the medical societies accept the new conditions the National Social Security Council (CNSS) has approved in response to demands by physicians and private clinics.
The CNSS ruled for increases in coverage and consultations for hospitalizations, diagnostic tests, medical fees and the use of rooms, equipment and other health services.
The National Social Security Council (CNSS) announced a 20% increase in honorariums for medical procedures and a 50% increase in hospitalization fees. This represents nearly three billion pesos more for the doctors starting in February 2023. There are also increases for the payments made for lab tests and the use of operating rooms and medical equipment. The private clinics will receive 15% more for their rooms, and coverage will be 100% for those insured and who are placed in rooms costing RD$1,712, and 90% for those rooms costing between that figure and RD$2,415. The latest resolution by the CNSS also calls for the Health Insurers (HMOs) to provide the doctors with the necessary codes.
Dr. Rufino Senen Caba said the physicians had walked out of the talks given that what was being offered was well below expectations. Dr. Senen Caba said the CMD would meet on Tuesday, 31 January 2023 and announce its official position regarding the CNSS resolution.
The special committee of the National Council of Social Security (CNSS) approved on 25 January 2023 Resolution 563-01 that calls to increase coverage for hospitalizations and consultations, doctors’ fees, diagnostic tests, hospitalization and the use of rooms and equipment, among other health services.
The CNSS approved a 20% increase in consultations, 15% in room coverage for hospitals and clinic rooms and equipment, and 7% in fees for examinations and diagnostic tests. The CNSS press release says this represents an increase of RD$2.7 billion a year. The increase would go into effect as of February 2023.
In this regard, the Health Risk Administrators (ARS) coverage for rooms will be 100% up to the amount of RD$1,725 and 90% between RD$1,726 and RD$2,415.
The resolution establishes that the ARSs must grant the codes to the physicians within 30 days after they complete the necessary documentation and requirements.
The CNSS did not address requests for an increase in services covered by the insurance, nor that the medicine quotas be triple and cumulative. The CMD is asking for a greater increase in coverage of medical consultations. Medics are also asking that disabled patients be treated at home.
“The agreement is very distant, nothing was achieved for the doctors,” said Dr. Senen Caba when interviewed on “Despierta con CDN.”
The CMD head accuses the government of being an accomplice with the financial sector that controls the insurance provider companies.
The CMD complained that the CNSS left out of the increased direct consultations with physicians and increases in payments for home consultations and emergencies.
Furthermore, the CNSS created a mechanism to monitor that the increases are not passed on to patients.
The Dominican College of Surgeons rejected the resolution. A press release from the surgeons describes the 20% increase for doctors in inpatient consultations and procedures as “insignificant and insufficient” and considers it an attempt to silence the just claims of health professionals. The entity stated that the Health Risk Administrators (ARS) will benefit by more than RD$294 million a month because the capita per member that they receive monthly from the TSS (Social Security Treasury) will be increased by 65 pesos, which as of February will be RD$1,555.14.”
The Dominican Society of Radiology said it does not support the resolution. Neither does the Dominican Orthopedics Society.
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31 January 2023