Promoting a regulatory change that aims to put an end to anti-competitive or unfair practices suffered by physicians in the practice of Private Medicine, is one of the main conclusions set out in the document ‘Report on the conditions of competition in the healthcare market private health system ‘, presented at a press conference of the General Council of Official Medical Associations (CGCOM).

The meeting, where the situation of doctors in this sector has been analyzed from the professional and legal field, has had the participation of the CGCOM president, Tomás Cobo, the national representative of the committee of doctors in private practice, Manuel Carmona and the expert lawyer in competition law, José Carlos Páez.

From left right: José Carlos Páez Romero, lawyer; Dr. Tomás Cobo Castro, president of the CGCOM and Dr. Manuel Carmona, national representative of the Vocal of Physicians in Private Practice.

In this sense, the report presented identifies and reveals the existence of practices that may constitute an infringement of current regulations on the defense of competition and unfair competition.

Specifically, the Cgcom indicates that the report reflects position indications of dominance position abuse in the relevant market by unilateral setting of scales; Unilateral imposition of other conditions of the commercial relationship or obstacles in the development of the activity of the physicians, among others.

Among these contrary practices, the vertical type collusive agreements between medical insurers and hospital groups also stand out, requiring exclusive or necessary collaboration from physicians, as well as the significant reduction of resources, among others. The expert in competition law, José Carlos Páez, has highlighted that all these behaviors are repeated over time and are located mainly from the year 2010.

Legal solutions

The report proposes legal solutions that aim to try to put an end to anticompetitive or unfair practices, promote a regulatory change, reinforce the defense of the interests of medical professionals who freely practice Medicine, on behalf of others or on their own, and obtain a compensation for the damages caused.

According to Páez, the legal solutions for physicians who carry out their activity on their own would be: request the National Competition Market Commission (CNMC) an investigation of the sector, promote codes of conduct as mechanisms for correcting unfair competition, establish in advance and in writing the contractual conditions and create different rate groups by medical act. On the other hand, professional interest agreements are proposed for physicians who carry out their activity as an employed person.

These legal solutions for physicians who carry out their activity on their own, they would ask the CNMC for an investigation of the sector; promote codes of conduct as mechanisms to correct unfair competition; set the contractual conditions in advance and in writing and create different groups of fees for medical acts.

On the other hand, professional interest agreements are proposed for physicians who carry out their activity as an employed person.

“These abusive practices lead to a clear deterioration of the doctor-patient relationship”

CGCOM President, Thomas Cobo

Cobo has highlighted the relevance of this report because “it was necessary keep studying and give solutions to our colleagues from the private sector in Spain, who have suffered abusive, anti-competitive situations for a long time. These practices also entail a clear deterioration of the doctor-patient relationship, so it not only affects our colleagues but also the quality of care for millions of patients ”.

The president of the CGCOM has explained the three fundamental axes that concern the medical corporation, and that especially affect the private sphere, which are job insecurity, wages and Continuing Medical Training.

According to the president, it is necessary to have stable contracts, “since even in the private sector sometimes there are not even contractual relationships, decent salaries equal to Europe, and to promote Continuing Medical Training updated and accredited in the international environment ”. In this line, he has referred to the recent agreement signed with the IDIS Foundation to promote, disseminate and accredit Continuing Medical Training in the private sphere through SEAFORMEC and UEMS.

A code of good practice

In order to solve the problems that affect the professionals who practice in the private sector, it is “imperative to create a working group in the CGCOM to prepare a Good Practice Code that regulates those three axes that affect the doctor-patient relationship ”.

“It is necessary a ‘Code of good practices’ that groups professionals, insurance companies and hospital groups to maintain the current private medicine system, or to advocate for a new model of free practice of medicine that guarantees, above all, the quality of care”

Manuel Carmona, national representative of the CGCOM committee of private practice physicians

Manuel Carmona has insisted on the commitment of the medical corporation in this area and has assured that “we are aware of the serious situation in which the sector has been for a long time, in fact, this house already put this problem on the table in 2019 with the presentation of the study “Conditions of competition in the private practice of Medicine” carried out by the National Vocal of Private Practice Physicians, which is the starting point of what we have discussed today “.

In reference to the results of the survey, Carmona has indicated that these constitute an important basis that aims to reflect the reality of the physician-insurance / hospital group relationships. In addition, the survey aims to identify potentially anti-competitive practices, analyze their compatibility with the regulations for the defense of Spanish competition and the European Union.

Obstacles for doctors in the private sector

The national representative of private practice physicians has exposed the need to make a proposal of legal solutions that include not only actions of the physicians that practice private medicine and the organizations that represent them, but also of these in cooperation with medical insurers and hospital groups.

In this sense, Carmona highlights that the doctor-pacient relationship “It is distorted by the conditions in which the new models of private practice are exercised, mediated by companies, due to the conditions set by insurance companies and hospital groups to the doctor, putting the quality of care at risk”.

On the other hand, the expert has pointed out that private medical practice “is no longer free under current market conditions”. This is due, according to your perception and the results of the survey, to two factors. On the one hand, the change that insurance companies have made to the classic model of private medical care, in which “they have gained a more prominent presence of care work, at the cost of weakening the ability to compete of physicians dedicated to private medicine ”. On the other hand, he points out that “the referral by insurance companies of insurance risk to medical professionals is remarkable, and this through imposition of capitative price formulas, of processes at a fixed cost or including techniques and procedures within the consultation perfectly individualized in the gazetteer ”.

For these reasons, Carmona maintains that the relationship between the doctor and the patient is subject to the conditions set by the insurance companies. In this sense, it highlights the concern of the WTO and its provincial schools to ensure the relationship with patients and care capacity.

“Private medicine is not attractive to young people or women, in the next 10 years 40 percent of the doctors practicing in private medicine will disappear”

Manuel Carmona, national representative of the CGCOM committee of private practice physicians

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