Government ordered the prepaid medicine entities to periodically deliver demographic, epidemiological, benefits and economic-financial information of their companies to be able to include them in three large groups that he created to categorize them, depending on the situation in which they are. The measure was reported through the Resolution 1950/2021, published this Tuesday in the Official bulletin.
The national authorities argued that it was up to “typify” these companies, “Providing the specific requirements that must be accredited to integrate each classification, as well as the requirements and obligations that must be met in each case.”
In this way, the firms that are currently registered, either definitively or provisionally, in the National Registry of Prepaid Medicine Entities (RNEMP) must, within the next 90 calendar days, request its inclusion within the new ordering scheme.
For this, they will have to submit updated data on all of its total and partial coverage plans that it markets to the general public, booklets, updated user registry, fees received and average, and balance sheet, among other points.
Once they do, they will be categorized into three large groups:
* Type A: It will be integrated by entities that provide at least one comprehensive coverage plan in the terms of Article 7, first paragraph, of Law No. 26,682, have more than 50,000 users and their average capita per user is equal to or greater than $ 4,000, a value that It will be updated in the same proportion and at the same time that the quota increases of the benefit plans are made effective.
* Type B: It will be integrated by firms that also provide at least one comprehensive coverage plan, but do not meet the rest of the aforementioned requirements.
* Type C: It will be made up of companies that do not comply with any of the established conditions.
If any company does not provide the requested data, the Superintendency of Health Services will proceed to classify it provisionally “in accordance with what arises from its previous presentations and will be empowered to intimidate the presentation of all missing information, arrange for comprehensive audits to be carried out, initiate summary proceedings in order to determine the appropriateness of applying sanctions and even proceed to terminate the non-compliant entity in case of not correcting its non-compliance ”.
On the other hand, when a firm is included in a category and, for whatever reason, ceases to meet its requirements, it must request the change of type within 30 calendar days of becoming aware of the fact that motivates the change. .
To the entities of Tipa A Specific trustees, auditors and / or overseers will be appointed for each of them that will analyze the information presented and will have broad powers to request additional information and / or to make the necessary corrections and / or adjustments.
Meanwhile, the data provided by Type B will also be reviewed by these officials, but they will be designated on a rotating basis and for each case, according to availability and criteria of analysis of risk or merit, opportunity and convenience, although it was noted that “All cases of suspicion or denunciation of irregularities will be verified.”
Finally, it was specified that the documents delivered by the companies included in Type C will only be inspected “in case of suspicion or denunciation of irregularities.”
In the recitals of the Resolution, the Government indicated that “Law No. 26,682 establishes the regulatory framework of Prepaid Medicine, reaching any natural or legal person, whatever the type, legal figure and name adopted, whose object consists of provide prevention, protection, treatment and rehabilitation services of human health to users, through a modality of voluntary association through membership payments, either in own effectors or through third parties linked or contracted for that purpose, either by individual or corporate contracting ”.
Beyond this last measure and its scope, for a long time the Government has tried to establish a discussion: for example, at the beginning of November the elected national deputy and former Minister of Health of the province of Buenos Aires, Daniel Gollan, refloated the debate on a possible reform of the health system, which at the time was supported by the vice president and widely criticized by a part of the business community.
“We were in a huge national health meeting, in which more than 15 thousand people participated, in which We began to discuss how to improve our health system, because the pandemic also taught us that we can do better ”he commented.
At the beginning of this year, when the issue began to be on the agenda, several leaders from the private health sector expressed their concerns about this initiative. One of them was Claudio Belocopitt, president of Swiss Medical Group and one of the main references of private medicine in Argentina, who at that time questioned the decision of the Government to eliminate subsidies that were in force during 2020 and suspend an authorization that allowed them to increase quotas by 7% paid by affiliates.
“There are an infinity of fantasies that do not have any logic. One of those fantasies is to create a single health system to have full power. Because if you create a single health system, not only are you going to administer it, but you are also going to decide which drug enters and which does not, and other questions.“Said the businessman on this issue.