Juan Abarca: “The doctor commands but subject to cost and effectiveness criteria”

—Tal and as we have revealed, these pressures are made through ATRES Bienzobas, an intermediary company hired by several insurance companies. Did you know this practice?

—Atrys is a company that, among many other things, provides assistance services to insurers based on cost criteria Effectiveness and clinical evidence to authorize treatments.

“Any time came to ears in the sector that increasing discomfort of oncologists?”

—The pressure exists since someone says that it does not authorize or that they do not believe that it has to authorize a certain treatment in a certain case. This occurs both in private health, and in public health. I do not know to what extent that degree of pressure comes or I have to think that criteria of the ‘Lex Artis’ have been breached. You cannot generalize what has happened. It cannot be said that all the oncology of private health is under those pressure models or following those criteria. I understand that it is the insurers who have to ensure and the oncologists agree on the protocols. If you do not agree with what they propose as normal is not to work with them. And if you think that patients are being subtracted, it is normal to denounce it: first to the insurer and second in court because if these cases are real are criminal. If this occurs in some cases, it does not mean even less that it happens throughout the private sector. We serve 30% of the oncological patients of this country. And fortunately most are treated according to the latest approved clinical protocols. If there are errors or cases that should not happen, they are limited, it is not the majority and they happen both in public and private health. I do not know the cases, the company and the insurers will have to speak, if they consider it appropriate.

—In the reported cases we see that in the face of advised therapy, Athrys proposes another more economical. Who decides it is an oncological advisor that is not identified. In the best case it is another oncologist who has never seen the patient, a pharmacist or an algorithm may. As an expert, do you consider this a good practice?

“No, this could never be a good formula, but I don’t know how far you get.” Behind Atrys there are oncologists that will have clinical protocols. If it were an artificial intelligence algorithm, the one to decide, would be against the law, expressly. That is a crime and therefore we should also chase him. But the free prescription of the doctor has limitations. The doctor is the one who sends but subject to cost and effectiveness criteria both in private and public health and in the concerted. The freedom of indication of professionals has even limitations by the drug law itself, in case a drug is financed or not. And that implies that sometimes you see protocols and drugs financed in hospitals and not in others. This does not mean that public health is doing badly but that the limit we are talking about is often very unclear. Here it has been deduced that the private health system only looks at the economic point of view. And the first that is governed by costs of cost and effectiveness is the Ministry of Health. We have 660 days of delay for the authorization of new drugs.

– In the cases that we have denounced the drugs that were hindered in the private one, they were already prescribed in the public.

-Could be. There may be errors, just as at a certain time there are doctors who are wrong in an indication. This is not an exact science. I also know cases that come out of the public health protocol and come to private to see if they can do any therapeutic action. I am not saying that the public is abandoning the sick.

—In addition to presiding Idis also does it in one of the large hospital groups in Spain. In their centers, the Atrays protocols operate?

—HM Hospitals prioritizes the criteria and protocols of my oncologists. I have clear that if at a given time we are not allowed to work with a patient based on freedom that our oncologists consider, which are also corporate protocols applicable to all HM hospitals, I do not work with the company. Directly.

– Does the investigation that SEOM (Spanish Society of Medical Oncology) seem to the ATRIS case seem timely?

—The Spanish Society of Medical Oncology has taken a long time, if this is really so. I should have acted before, as in many other things. Such as not allowing hospitals to allow protocols and others not. ATRES has not worked since yesterday: he bought well zoobas two years ago and well worked for many years. That now the Seom takes your hands to the head saying that it will investigate it … for that the scientific societies, to ensure the quality of care, in addition to financing the training and manage the money of the industry. And professional schools are here to protect patients, not doctors. They are the ones who would have to ensure the Lex Artis, as they do in the United States through the AMA.

“Are you going to investigate too?”

“No, Idis is not for that.” Its mission is to try to value the private health system and that the system works as well as possible for all Spaniards. What we want is that if there is any irregularity, leave, resolve, clarify and do not happen again.

—All insurers hire Atris for a capita, a fixed amount per insured. This only favors that the intermediary tries to reduce costs, don’t you think?

“I deconoz if Athrys works like this.” I do not receive any capita anywhere. I cannot assume the risk of the insurer.

“We know that she does it with three insurers, should it regulate?”

“I don’t think it would have to regulate it but to eliminate it.” The risk of the incidence must be assumed by insurers. The risk of a third should not be transferred, that is my opinion. Everyone has to ensure their risks, not being financial. The capitas must be removed.

—What measures could be taken to end the pressures to oncologists?

“I insist that I think this is a limited thing.” If there has been any irregularity I imagine that this will be enough for entities to take measures to control them.

– Would it seem good that the oncological advisor must identify with name and surname and collegiate number so that the oncologist who prescribes knows if he is talking to another oncologist or with a pharmacist?

“That seems elementary to me.” It has to be from oncologist to Oncologist. It cannot be another person and less an algorithm because that would go against the law.

“A.Try’s practices were an open secret?”

“Well, there is always rumors of everything.” Just as there are rumors that private health cares only, or that public health has an absenteeism of 30%.

—The patients who do not get the treatment recommended by their oncologist, resort to public health. A recent airf report ensures that 70% of cancer patients end in public hospitals and 90% if they are young.

—It looks like that said, but that report also says that 50-60% are extreme and serious cases. And that, of those cases, 30% are financed by insurers. It seems that there is a risk selection but there are no complex private facilities throughout the national geography. That report what it intends, is to end up charging the model of the officials. The most important thing is that without mufface the waiting list for consultations by 30%would be increased. If for ideological reasons they decide to eliminate the model is an option. But you have to start reforms in the system.