Much is discussed these days a “rescue” to private health and, in particular, an agreement that avoids, in the words of the Association of Isapres, that these private entities fail. Beyond the contradiction that means for those who defend private health to limit all interference by the State and, however, now that they are in crisis knock on the door of the State itself to save them, the truth is that it is important to explain, I hope with simple and summarized words, the problem of private health and what was resolved by the Supreme Court in two judgments issued in 2022, that rocked this lucrative industry.
For years we have witnessed the judicialization of the increases of health plans every time the isapres have tried to raise the base prices agreed in the contracts. These increases have always exceeded the readjustment of the annual CPI, and the reason was due, according to the isapres, to the fact that health costs rise above this readjustment. Given this, the sharpened (as) claimed such increases through protection resources presented in the Courts, which were practically entirely accepted, since our justice has considered that what was agreed in the contracts is constitutionally protected law and, even though the isapres had the legal power to raise such plans (article 197 third paragraph of D.F.L. No. 1 of 2005), This was to be used exceptionally and for a substantial and objective alteration of such costs, and not in a general and abusive way.
This judicial problem dragged on for years wanted to be solved through the issuance of a new law, No. 21350, which provided that it would be the Superintendence of Health that would set a maximum percentage increase in the base prices of the contracts, but maintaining the obligation of the isapres to justify their increases. What did the isapres do? Given this indicator, they simply applied the maximum limit set by the Superintendence of Health at 7.6%. Here came the first sentence – or “supremazo” – issued in August 2022 by the Supreme Court, which annulled such increases and made it effective not only with respect to those who filed protection appeals but in favor of all affiliates, ordering the restitution of what they have charged for such increases.
Undoubtedly, the Court shows its weariness with the permanent interpretative abuse that the isapres have done. The reasons of the Court could be summarized in two: 1.- The circumstance that the Superintendence of Health establishes a maximum range, does not release the isapres from having to objectively justify such increases; and 2.- That it is an attack on competition, which is so proud to defend the private world (this I say, not the Court), the fact that all the isapres have set the same maximum limit of 7.6%, “where the price is a critical variable of choice of Isapre (and health plan) for the beneficiaries of the system” (verbatim quote from the Supreme Court ruling).
The second “supremazo” was dictated in November 2022. This time it said relationship not with the base prices but with the tables of factors that were discretionally determined by each isapre at its own discretion. These tables establish different percentages of risk by age and sex. Thus, for example, older people or women in the fertile stage have a greater risk for the isapres in the use of health and, for this reason, they assigned them a higher factor number, which multiplied by the base price determined what each member or affiliate had to pay for their plan. This generated the perverse effect of pressuring our grandfathers and grandmothers to abandon their contracts because of the onerous payment of the monthly contribution, benefiting that the isapres keep the youngest people, less likely to use health benefits and, consequently, less expense for the isapres, thus increasing their profits. The Supreme Court put an end to such abusive discrimination and confirmed what the Constitutional Court had already ordered in 2010, namely that the difference based on sex and age is unconstitutional, since it violates the principle of equality before the law. Of course, it accepted a fixed risk difference by age, but limited to the application of the “Single Table of Factors” provided by the Superintendence of Health, whose digits are considerably lower than those used by the isapres.
Faced with these two sentences, the isapres turned their pressure on the Government under the euphemism of saving the health of private affiliates, when in reality they request a rescue for their businesses. The The government opened a dialogue table to interfere in a matter that is private, but with social effects, at least for a percentage of the population. However, in an act that shows the state of desperation of the isapres, they decided to freeze their participation in the open dialogue table with the Ministry of Health under the argument that “the only proposal that the Executive has outlined points to a package of reforms to Fonasa” (isapres statement of January 27). Frankly unusual, they go for help to a problem generated by themselves and want to impose their conditions.
Without yet materializing in Congress the formal entry of a health reform, the substance of what should be presented is what has been discussed informally and that does not aim to “nationalize health,” as is interestedly claimed, but to transform it into a social security contract. Chilean health, both public and private, is very much in deficit in coverage, which clears any attempt to eliminate one or the other, on the contrary, they must be integrated without losing their character. The Organization for Economic Cooperation and Development (OECD) recommends that the minimum number of beds per inhabitant be 4.8 per thousand inhabitants. In Chile we are far from the standard: we have only 2.16 beds per thousand inhabitants.
What is sought with the health reform is that, at least what is mandatory contribution (today at 7%), is administered by a single health fund in charge of the State, and if someone, due to their better economic situation, wants to improve such a basic plan, they can do so by hiring a private insurer (they could be the same converted isapres), paying a voluntary contribution in addition to the mandatory one. In practical terms it means the following: if someone wants to be treated in a private clinic, obviously they can do so and the final bill will be paid, in the proportion of the plan that the contribution would oblige, by the public entity that administers it, and on this, by the private insurer if so contracted. What is achieved with this?: solidarity.
In fact, today the mandatory contribution for those who hire isapres is administered by these same entities and, as we well know, we do not all get sick at the same time, that is, there is a no lower percentage that simply constitutes profit for the isapres, more when their majority affiliated age group are not older adults. What is intended is that such mandatory contribution, being administered by a public body, such “profit” generated by contributors who do not get sick, serves to benefit the rest of public health and not the pockets of the shareholders of the isapres. Only the voluntary contribution will remain as a business for the private, that is, they maintain their niche, somewhat smaller by the way, but above all public health wins.
A little solidarity helps the social soul and does not poison it.
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The content expressed in this opinion column is the sole responsibility of its author, and does not necessarily reflect the editorial line or position of El Mostrador.
