The actual value of well being care and the ‘gaps’ that aren’t coated by non-public medical insurance

Private medical insurance registered an annual improve within the variety of insured and Spain already has 12 million individuals who have signed a non-public well being coverage”Public well being spending per Spaniard is near 2,000 euros and personal about 1,000, in complete about 3,000 of complete well being spending”, says Juan Simó, a household physician and writer of the weblog Salud, Dinero y Atención Primaria. It is critical to “make residents conscious of the true value of well being care with a purpose to modify insurance coverage costs”

This is acknowledged within the report ‘A well being system in transformation. The challenges of personal insurance coverage in Spain’, ready by the Chair of Responsible and Sustainable Health of the Complutense University of Madrid and promoted by the Spanish Private Health Alliance (ASPE), which particulars that “low-cost insurance policies linked to a change within the mannequin the place residents make rapid use of the contracted coverage is resulting in a saturation of the non-public system, with ready lists in sure specialties and a discount within the time devoted by professionals to sufferers in consultations”.

The research additionally highlights that in Spain, non-public medical insurance registered an annual improve within the variety of insured of 4% between 2017 and 2021, with a rise within the quantity of premiums at a fee of 5.1%. In this manner, Spain already has 12 million individuals who have subscribed a coverage of those traits, the place 78% corresponds to well being care insurance coverage, 15% to administrative mutualism and the remaining 7% to reimbursement insurance coverage.

The doc emphasizes the saturation in non-public consultations. It is indicated that it’s essential to “make residents conscious of the true value of well being care with a purpose to modify insurance coverage costs, progressively improve the scales paid by insurers to suppliers, enhance the effectivity of care processes and steadiness the construction help to the insurance coverage supply”.

With the newest up to date knowledge for 2022 supplied by the Spanish Union of Insurance and Reinsurance Entities (UNESPA), that is the rating of the ten non-public well being insurers:

Ranking of personal medical

The ‘unhealthy dangers’ of the non-public system

Simó assures that “at present, by 2023, public well being spending per Spaniard will probably be near €2,000. If we add to this the typical non-public well being spending per inhabitant (about €1,000) we now have an approximate complete that may nearly attain €3,000 of well being spending complete (public + non-public) by Spanish”. This equates to about 250 euros per 30 days.

This supposes, warns Simó, that “we now have a public well being system that features the unhealthy dangers of the non-public system, in fact.” By unhealthy dangers we imply the upper prices of sure illnesses (transplants, screwed up tumors and intervention, dialysis, sure medicine, eg chemo, antivirals reminiscent of hepatitis C, and many others.). That is to say, the most costly factor will not be coated by non-public healthcare as a result of it is aware of that the general public can do it.

“The costs of personal medical insurance coverage in Spain could be a lot increased (even good insurance coverage) if there have been no public community that takes cost (as a result of the overwhelming majority of Spaniards are entitled to it) of unhealthy dangers,” he explains. Simó, who insists that personal medical insurance performs a job that has all the time been thought-about “complementary” to the general public. Destined, on the whole, for outpatient consultations with specialists (for which they’re most used) and for hospital admissions for minor points, at low value and providing enhancements, with respect to the general public, in resorts (single room with piped music and mattress for a companion , For instance). In different phrases, in precept, non-public insurance coverage doesn’t intend to “compete” with the general public in all aspects of the service and, due to this fact, doesn’t intend to play a “substitute” function.

Preference to make use of non-public insurance coverage

With all this, individuals who have non-public insurance coverage, once they reply query 5a of the Health Barometer, specific their choice for utilizing their insurance coverage relatively than public well being for any of the instances introduced within the query apart from “a remedy for a severe or complicated illness (for instance, most cancers, coronary heart surgical procedure, and many others.)”. Especially vital is his choice for personal medical insurance relatively than a public hospital when present process hip, inguinal hernia or gallbladder surgical procedure.

“Years in the past it could have been unthinkable that somebody would like to have a hip substitute surgical procedure by means of their non-public insurance coverage relatively than by means of the general public one. Among different issues, as a result of many insurances did not even cowl it as a result of the prosthesis was (and is) very costly. I believe most of sufferers with non-public insurance coverage have no idea that, when the second of reality arrives, their ‘low value’ medical insurance would cost them individually for the hip or knee substitute, which is a number of thousand euros extra”, concludes Simó.

Transparency and making certain continuity

The report in flip speaks of bettering the transparency of well being insurance policies and offering them with better readability, specificity and ease to facilitate understanding within the face of a posh choice with so many insurance coverage firms and so many presents. The doc additionally warns about “the necessity to assure the continuity of the insured’s well being care no matter his pathology and his age.” He talks about power illnesses or these complicated ones, reminiscent of most cancers, and factors out that “this reflection is carried out in view of the dangers that insurance coverage firms might restrict accessibility to some companies; situation the supplier’s choices; improve the value of insurance coverage premiums considerably, and even expel the insured”.