A system splattered with failures
In the 14 years since the creation of Law 87 – 01, the authorities have not managed to fulfill the transcendental universality
SANTO DOMINGO. That every person should have adequate protection against the risks of illness, disability, old age, infancy and work, is the idea which motivated the creation of Law 87 – 01 on Social Security which, in addition, pursued the fulfillment of article 8 of the Dominican Constitution, which calls for stimulating the progressive development of this system.
The legislation enacted 14 years ago was expected in just one decade to place the country among the most advanced nations of Latin America in this area, but it has remained behind.
The postponement of the start of the Subsidized Contributive Regime, which leaves outside of the benefits that should be granted by the system, the great mass of informal workers of the country; the lack of a strategy to strengthen Primary Attention, which would guarantee access to health, and reduce the cost of consultations, as well as the low interest for offering a dignified retirement to the older adults, are some of its principal failures. These are points which, as they are conceived in the Law, should be benefiting the citizens.
To be specific, of 9,888,817 inhabitants registered in the national territory as of January of this year, there are still 3,660,602 that are to be found outside of the Family Health Insurance (SFS), in spite of the fact the regulation referred to in article 18, calls for obtaining a universal coverage in health without exclusion for age, sex, social, work or territorial condition, in order to guarantee access by the most vulnerable social groups.
While this group struggles for inclusion in a medical insurance, 6,228,215 affiliates, 3,032,565 in the subsidized regime and 3,195,650 in the contributive (payroll deduction), have to face the annoyance of the low coverage of medical procedures and medications, also foreseen by the Law in its article 129, through the creation of the Basic Health Plan, which in place since 2006, as working with a Plan of Health Services (PDSS), approved by all the sectors that make up this System, in order to “make possible the entry of the SFS.”
The idea was to establish copayments, limits and gradualness in the delivery of the services offered by the Basic Plan, which contains the attention to which the persons have a right and to achieve a financial sufficiency in order to avoid the economic collapse of the System in the first years.
The commitment consists in revising this PDSS every year, but this has not been fulfilled. Nine years of testing have passed, and the sectors that make up the Family Health Insurance have achieved the consolidation in the business. They have seen the number of affiliates grow, as well as the earnings which they receive. Nevertheless, the benefits are not converted into quality services for the affiliates, and this is not unknown to the authorities.
The head of the Superintendency of Health and Labor Risks (Sisalril), Pedro Luis Castellanos, feels that the PDSS has been backward , not only in its content, but also in its conception, so that he feels that this is the time to return to the initial ideas of the Basic Health Plan, with a guaranteed coverage for some priority health problems, without restriction and without limits, such as the catastrophic diseases, which, as the PDSS is made up, have very low coverage, “while other less tragic illnesses, which affect in a lesser degree the family which can probably have another type of coverage.”
The change of the Basic Plan has given way to copayments which increase (the cost of) health services. To visit a specialist in this country can cost as much as between RD$500 and RD$1000 with insurance, and as much as RD$5000 without insurance, depending on the specialty. To this has to be added, the time which the patient has to wait in order to be attended, and the extra amount that an insured affiliate has to pay the doctors, in case of carrying out some surgeries.
“Here the doctors are waiting for you to get sick in order that you arrive at the clinic with the problem that is going to cost you a lot of money,” Eduardo Read, the president of the Dominican Association of Primary Care Companies (ADOCAPS) told Diario Libre. Read is in favor of prioritizing Primary Care in the country, as an answer to the problems which the national health system faces, such as those pointed out by the World Health Organization (WHO).
Article 152 of the Law, speaks of a level of primary care as the entryway to the network of health services, with professional basic attention to the population its responsibility, provided with an adequate capacity to resolve and concentrating on prevention, on health promotion, on monitoring actions and in the tracking of special patients, which covers emergencies and home care. Also they law on speaks of centers conceived so that rich and poor can go for a consultation, and receive a quality service at low costs.
As the Dominican Social Security System is structured, people should work for 30 years uninterrupted, in order to begin to collect a pension which, in addition, would represent the third part of their last salary. Around 1,513,581 contributors are facing this reality.
One part of the pensioners of the Dominican Institute of Social Security (IDSS) suffer the weaknesses of a system which has still not been able to include 54,575 pensioners and retirees in the Family Health Insurance, while the total, 108,208 elderly, receive pensions of RD$5117.50 and less, which maintains them in a constant condition of complaints, hopeful that the government will increase their pensions to a level that will permit them to cover their basic necessities.
The indigent and childcare
In what refers to the indigent which, according to the regulations should receive support from the System, their notable presence in the streets which many use as their homes, gives notice that it is an element on which there is still work to be done.
Regarding childcare centers, according to the Administrator of Safe Health Childcare Centers (AESS), so far only 49 are functioning which favor 7907 children. However, it is estimated that they should benefit, in relation to the infantile population of the Contributive Regime in the 10 provinces that are economically active, some 255,543 children from 0 to 4 years of age, for which they would need 897 centers, each with 14 rooms with a capacity for 310 children.
And the money
Does the Dominican Social Security System have sufficient resources to provide answers to society’s demand?
As of 30 April 2015, the income collected by the Social Security Treasury reached the amount of RD$24,840,788,213.10 for an increase of RD $2,660,072,315.01 in comparison with what was collected during the same period of 2014, representing an additional growth of 11.99%, which makes some actors of the System, such as Pedro Castellanos, think that the principle challenge which they now have, especially on the part of the SFS, “is to achieve that the citizens who reside in the country receive the benefits to which they have a right.”
The transformation of the Dominican Institute of Social Security (IDSS)//The creation of the unique network of public (health service) providers (pending in the Congress)//The separation of the stewardship of the Ministry of Public Health of the hospital network//The creation and revision of the Basic Health Plan (what exists is the PDSS, not provided for in Law 87 – 01)//The reduction of copayments//A readjustment of the limit of RD $3000 for outpatient medications//The revision and updating of the catalog of services of the PBS//The revision and updating of the catalog of medications//Expansion of coverage of the childcare centers and health for the pensioners//Achieve universal coverage, reduce evasions and avoidance by the business owners.
June 2, 2015
Category: DR News |