With an acceleration of cases in recent weeks, the confirmation of the detection of new strains in the country and a vaccination process that is much slower than scheduled – until Friday afternoon 3.7 million vaccines were applied – The force with which a second wave of Covid can impact is generating many concerns in different areas. Among the first to see the arrival of the second wave head on are the clinics and sanatoriums that make up the country’s health system and which, according to estimates from their referents, last year dealt with 7 out of 10 patients diagnosed with coronavirus .
The fragile financial situation of the private system began to generate internal tensions – a series of wage claims began last week – and threatens to worsen due to the advance of the pandemic.
It is clear to entrepreneurs and executives in the private sector that there is a set of enormous distortions in the health system. “These distortions are outdated rates, since the average rates are not covering the costs; different funders pay different amounts for the same benefits and this impacts health institutions depending on the mix of funders they have; and thirdly, in all the funders the rates for the different services are totally distorted ”, they point out.
These conclusions are some of the ones that came from a study by the Health Economic Analysis Forum prepared by Economic Trends SA With this report, entitled “How the private health system reaches the second wave”, the directors of the Association of Clinics, sanatoriums and private hospitals of the Province of Córdoba (Aclisa) try to show compelling arguments for a recomposition of financing, while generating a substantive debate on the sustainability of the entire private system.
Delay and distortion of rates. The report highlights that the privately managed health system is an essential component of the health system, since it serves more than 60% of the population. “For this reason, the fragile economic and financial situation of the entities that comprise it, aggravated during the first wave of the Covid-19 pandemic, represents a serious problem in the event of a second wave in the coming months. It happens that the average rates of the different funders do not cover the costs of key services such as hospitalizations in the flat and ICU, and the peaks of the pandemic exacerbate the problem, by reducing the occupancy rates of normal services and substantially increasing costs. of Covid patient care, ”he says.
And it reports that the rate problem is not only linked to its average levels, lower than costs, but also to the marked distortion of rates between funders and between medical services and practices, which implies different levels of vulnerability of
entities depending on their mix of funders and their mix of services. “The distortion of rates between services implies conjunctural problems, such as underfunding that occurs when the pandemic causes a drop in the number of practices with higher rates, such as surgeries that, in some way,” finance “deficit services such as hospitalization, and problems more structural, such as the lack of financing of the entities of smaller localities as the more sophisticated services are concentrated in the big cities ”.
“There is a problem of delayed rates that has been going on for a long time, but it has worsened. It also worsens when occupancy rates fall as when it occurs in each wave of Covid, it happened last year and is likely to happen now. And added to all that, there is a problem with the rate structure where there are cross-subsidies that are affected by the pandemic. It is common for surgeries to “subsidize” the cost of the floor, but that system falls apart when surgeries are cut off due to the fall in demand that Covid implies. This implies that the floor or ICU services are uncovered, without being able to cover their costs, generating several complicated derivations in this regard, ”explains economist Gastón Utrera, at the head of the team that developed the work.
Uncovered costs. The Health Forum report indicates that, with data from the Health Costs Statistical System, as of March 2021, the total cost coverage rates of the funders considered vary between 27.2% and 65.9% of the total costs in the case. of hospitalization in the flat, and between 44.0% and 92.1% in the case of admission to an adult ICU, depending on the funder. “In general, not even operating costs are covered, even excluding payment of employer contributions and provisions for dismissal, and considering state aid in the form of REPRO,” he says.
“To the question of ‘How does private health reach the second wave’, the answer is very bad. We are much worse than last year. We come to this second wave as if we were a boxer who fought 15 rounds, they give him a minimum rest and put him in a new fight against a fresh boxer, because the Covid comes with new versions. That is the feeling we have. We have a minimum delay in rates of 50% or 60%. And the impact of inflation in our sector is different, for various reasons such as the prices of new drugs, imported supplies or the concentration of manufacturers “, remarks Mario Hornik of the board of directors of Aclisa.
It gets worse. For the next six months, while the second wave develops, under extremely conservative assumptions of salary increases, drug prices, and exchange rates, among other variables, costs could increase 19.8% (hospitalization) and 20.7% (hospitalization). in adult ICU) on current values. That implies that rates should be increased by about 20% just to maintain the current rate delay under current conditions. “In other words, we need a 20% increase in the coming months to continue losing what we have been losing today, that we have a loss crater. With this it is clear that we must rethink financing, but the whole system in general ”, says Hornik.
Hearing on Tuesday between companies and workers for wage claim
After the Ministry of Labor of the Nation dictated the mandatory conciliation for the conflict that confronts workers and private sector clinics and sanatoriums, the parties were summoned for a hearing on Tuesday, March 30. The conflict escalated from Thursday when assemblies began at workplaces and 3-hour shift work stoppages, demanding a salary recomposition. That measure continued on Friday, until the ministry’s mandatory conciliation arrived. As reported, the media was adopted for 15 days to “void, during the indicated period, any direct action measure that was being implemented and / or planned to be implemented, providing services in a normal and habitual manner.”
On Friday, one of the leaders of the sector and the CGT, Héctor Daer, pointed out on his social networks: “Today, in the midst of a pandemic, (the workers of) the Health of the whole country are on strike in demand for a fair and dignified salary recomposition. We are highly compliant with an exemplary union action measure, the health workers, and we demand that our efforts be recognized ”.
For companies, there is little margin to attend the claim if there are no gestures from the State or an increase on the part of the funders. “From the sector we are willing to increase wages and to keep up with inflation; We understand the claim and accompany that need for updating, but the resources are not yet available to resolve the situation. For this reason, we hope that the funders and the Government will join the table so that, together, we can find the financing of the system, which allows us to update the values of the salaries, “said a source from the Argentine Federation of Health Providers (FAPS) to CORDOBA PROFILE. In this regard, Hornik depicted the situation with a piece of information: “in all of 2020, with all that we have experienced, the increase that Pami gave us was 0%, not a penny. This is impossible ”.
Covid bed cost rose 38.3%
According to the Statistical System of Health Costs, the cost of hospitalization in ICU Covid-19 is $ 61,687 per day and per bed under the assumption of 50% occupancy rate. In March 2020 that value was $ 44,607.