The Ministry of Health attends, “without surprise”, to the complaints of oncologists of the private sector that are limited their ability to prescribe the best treatment to their patients. Complaints, which have revealed ABC, show how insurance companies use the intermediary … Porthezobas to press the oncologist and change the prescription, almost always for a cheaper drug. The Spanish Society of Medical Oncology has already begun investigating complaints that do not reflect only a “strip and loosen” between companies and health professionals, but a serious damage in patients, in the case of not receiving a treatment that can change its vital prognosis.
– Many of the treatments that are rejected are available in public health, where its effectiveness has already been studied. Are you surprised?
“No, it doesn’t surprise me.” These practices will continue to be produced because health collides with the interests of companies, as we are used to see in the United States. In Spain fortunately this does not become a scandal because we have a public health in which innovations are incorporated. The patient who does not finance the treatment in the private ends up going to the public network. These practices will continue to be produced because public health ends up being the security network.
—Do unknown the use of high cost oncological drugs in the private and the transfer of patients to the public can be considered fraud?
“In legal terms, no.” As we have already denounced, private health insurers who served MUFACE use risk selection practices. We have denounced it based on published scientific literature and the prevalence data of disease in mutual patients with public health. Income from oncological diseases in public hospitals are disproportionately more prevalent among mutualists than among the rest of the population. ABC’s complaint is the nth example of these risk selection practices.
—The CSIF union has asked the government to investigate these practices that especially affect officials who choose the MUFACE model. Will the Ministry of Health do it?
“No, we don’t just have us.” But we believe that transparency should be advanced, so that the sick know well the coverage of the policies they hire. The patient platform has already asked us for a meeting to address this issue.
“Do you know how Atrys-Bienzobas works?”
—They have sent us an argument following this controversy to clarify their work. They justify that all they do is because of the correct use of resources. What they do not explain is whether this means pushing patients from private to public health or why they reject medications that are used in the public network and in which their cost-efficacy is reasonably established.
– The oncological treatments are increasingly expensive and the number of patients will increase. That affects public and private health, should the private insurance model be rethink? Promote public-private collaboration?
—In Spain we have a private assurance model based on cheap policies. Whoever hires it thinks that for 50 euros a month will have access to all treatments. This system is hardly sustainable, makes waters on all sides. In a context of innovative therapies of high cost and high value like the current one, it is very difficult for private health to be sustainable. It is a matter of economy of scale, negotiation capacity with the industry. It is not the same to negotiate with the weight that 40 million inhabitants of the National Health System give than with a thousand.
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