After all, why do doctors want to withdraw consultation from fixed health insurance coverage?

After all, why do doctors want to withdraw consultation from fixed health insurance coverage?

A medical consultation is usually the first – and, often, the only – contact many people have with the health plan you chose to invest. It is the gateway to the enjoyment of private agreement , the first return that has this investment.

After all, who never underwent a medical check-up to see if it’s all right to health, only as a guarantee and as a way to “use plan that is standing there,” with monthly religiously being paid every month?

Fixed covers health plans – whatever it may be and the chosen mode – usually provide for the medical consultation as the most basic of services offered to the user. It is basically from where everything else begins, the query takes the exam, which can lead to hospitalization, which can still result in surgery.

Thus begins the path of the patient within the private health system . This routine, however, may now change. That’s because the Federal Council of Medicine (CFM) has advocated rule changes involving the offer of consultations within the health plans.

The suggestion, according to the agency, is to remove the queries of the agreement offered by carriers and cause the user proceeds to pay for this type of service. Such a proposal was made public in July this year by the president of CFM, Solomon Rodrigues Filho, during the course of the Special Commission public hearing on Health Plans of the House of Representatives, and has led many people to speak out about it.

Why might this happen?

It is not news to anyone how doctors go dissatisfied with the remuneration they receive from the health plan retroactive to queries that promote the covenant of service. There is no fair compensation, according to them, and spending on care and procedures performed just overlapping the return value.

According to the Brazilian Association of Health Plans (Abramge), professionals receive on average $ 80 operators for carrying out a medical examination, an amount that varies according to the type of specialty.

This gradually has made many doctors migrate to other agreements or, as a last resort, give up acting within the private health system. There is increasingly less available professionals within the health plans.

You, by the way, must have felt it on the skin when trying to schedule an appointment: the first vacant hours, sometimes it’s only five or six months later, when the query is offered by the health plan, but if done so particular, there is room for the next day.

Therefore, remove the health plan consultation solve not only this dissatisfaction of professionals, as well as the hole that health plan operators claim to have every year – which has justified the low wages passed on to doctors.

For the president of CFM, this strategy desoneraria the system and inhibit the indiscriminate use of elective consultations.

How would this withdrawal?

The proposed CFM involves only withdrawal of calls elective consultations – when there is no urgent or emergency in the case when there is no health risk to the patient or when there is no medical need within a short time.

They are, therefore, routine queries that the patient is to find out if it’s okay or get some advice or medical advice about mild symptoms and will not jeopardize the health, such as headache, muscle or joint pain, fever , flu, cough and insomnia.

So whenever the patient to schedule an appointment that is not urgent and emergency, will have to make payment in a particular way to the doctor that meet even that is already user of a health plan and already make, therefore, the payment of your tuition.

There is however one exception: depending on the contract it has with the operator, the patient may be compensated by the payment made by the query. These are specific cases where the plan mode chosen by the user provides coverage for elective consultations – which, in this case, will be the exception and not the rule.

Still there will be an annual limit of these consultations, unlike how it works today, when the patient can consult as many times as you want and with the specialties he wants.

In this case it will make regular payment to the doctor at the time of service, will get a receipt and, by presenting the document to the service provider, you may receive or not the invested money back. That would depend, as said, the kind of agreement that he has.

This change would be radical?

If the proposal defended by CFM materialize and the National Congress to approve changes in the laws of health plans, almost 90% of the additional system market would be affected, according to a forecast by the Brazilian Institute of Consumer Defense (Idec).

For the body, the change would directly affect the market and cause a turnaround in the industry, especially as many of the health plans now offer agreement that includes consultations.

Today, however, there are already more targeted plans, which exclude the covenant of service, but this type of plan is a very low average of all – about 1.19% of the market. “The impact of this would be tremendous,” says the lawyer Idec, Ana Carolina Navarrete.

Regardless of the impact it will have and what will happen, eliminate elective consultations fixed coverage of health plans is not something that will solve overnight.

The proposal defended by CFM should still be thoroughly discussed and evaluated between the medical classes, the representatives of the legislature and society, especially by the changes it will cause in all the country’s health system, both the supplement and the public – where to spill most of these changes.

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