DR ONE NEWS SUMMER 1999
August 1999
1. Will physicians strike against insurance companies?
More than a million Dominicans would be affected if private physicians accept the Dominican Medical Association's call to strike. Dr. Rafael Mena, pesident of the Association of Clinics and Private Hospitals (Andeclip) said that the paralization of medical services at private clinics and hospitals, set for this week, would affect about 1,200,000 Dominicans that are affiliated to private insurance plans in the DR.
The private clinics and many physicians have frequently demanded that medical insurance companies increase the moneys paid to them for their services. These, they say, have not been increased in the past eight years.
There are three tiers of medical service in the DR. These are: the public hospital system (used by indigent Dominicans and those seeking the least costly of medical services); the medical insurance system (which makes most private medical services accessible at low cost to those employed or individuals purchasing these plans); or the relatively expensive private medical services (these vary in prices going from less expensive at private clinics in low income areas to very expensive (RD$400-RD$1,200 per visit) at private clinics and hospitals.
Recently, the Dominican Medical Association sponsored a series of strikes at public hospitals that resulted in Congress passing a bill providing the moneys to fund a 75% salary increase for government-employed medics in a six months time period. Now the same association seeks to get better pay conditions for medics that receive patients affiliated to private medical insurance plans.
The medics complain that they are paid only RD$60-RD$80 per patient seen, and that many insurance plans delay up to four months in paying these moneys that the insurance companies collect in advance from companies and individuals. The insurance companies say that they guarantee a large volume of patients to the physicians. Accepting to be part of an insurance plan is voluntary. Several well established and high reputed physicians do not accept patients that want to pay using their insurance plans.
In an editorial, the Listin Diario points out this is an option that private physicians have. The newspaper says that if the physician is not satisfied with the service, it does not have to stay affiliated to the plan. The insurance companies offer a service that they do not necessarily have to purchase. The newspaper criticizes the AMD's decision to lobby for the physicians. The newspaper said the strike would be inhumane and of crime-like nature. It urges the clinics, physicians and AMD to sit down to talks.
Unemployment declines in DR
CEPAL, the Economic Commission for Latin America, estimates that the urban unemployment rate in the DR dropped 1.1% in 1998 compared to 1997. According to data, the urban unemployment rate declined from 15.9% to 14.3 %. This is down from the high of 20.3% registered in 1992.
5. Private clinics fight for increase in insurance retributions
The Asociación Nacional de Clínicas y Hospitales Privados, (Andeclip), which groups private clinics in the DR, has joined forces with the Asociación Médica Dominicana and is threatening to not accept insured patients. Andeclips wants the Asociación de Igualas Médicas, which groups companies providing medical insurance plans, to sit down to talks. Andeclip wants medical insurance plans to increase moneys paid for their services. Andeclip and the AMD are threatening to strike next week, maintaining services only to full price paying patients. The Council of Businesses (CONEP) has sided with the Asociación de Igualas Médicas saying that neither the clinics nor the physicians have to accept insured patients. Several physicians with large practices do not receive patients on insurance plans.
Sept 2 1999
6. Clinics and physicians in northcentral regions go on strike
Private clinics and their physicians in the northcentral regions of the DR went on strike today protesting what they consider unfair contractual conditions with medical insurance plans. The Dominican Medical Association has joined the Association of Dominican Clinics (Andeclip) in their plight to get better conditions from medical insurance companies for clinics and physicians serving those on medical insurance plans. The system has worked well for the consumer, but now the medical establishment feels they are not getting a fair share in the business.
In the DR an estimated 1.5 million Dominicans (mostly employees) benefit from the medical plans that provide high cost medical services to Dominicans at very reduced prices. It is estimated that 80% of the patients attending private clinics are on some kind of medical insurance plan. Some 225 clinics are affiliated, and some 8,000 physicians.
Yesterday, 80 member physicians of the Dominican Society of Neurology said they are resigning from their contracts with medical insurance companies in protest for the low fees paid for their services. This was the first association of specialists to cancel their contracts with the medical insurers.
The clinics and physicians gripes:
The medical insurance companies are making a 50% profit.
The medical insurance companies delay up to 90 days in making payments for their services, despite getting paid in advance by affiliated companies or individuals (individuals need to pay an entire year in advance).
Physicians are paid RD$60-RD$160 for seeing a patient and RD$100-RD$300/day for seeing a patient that is hospitalized. Physicians charge their private patients five to ten times that amount.
Insurance companies do not differentiate when paying a specialist or a generalist.
Contracts prohibit them from charging insured patients more than minimal difference (about RD$20).
Insurance companies make the same per service payments regardless of the equipment and facilities offered by the clinic.
Medical insurance companies position:
The medical insurance companies gathered under the Cámara Dominicana de Aseguradores (CADOAR) say they have signed contracts individually with the clinics and physicians. They say they will only negotiate on an individual basis with clinics and physicians. They say that they provide volume for the clinics and physicians, and thus the reduced price for the service.
They have said they will cancel the contracts with clinics or physicians that unilaterally do not respect the clauses.
7. Manatees make their home at East Coast beach
Dozens of manatees have been spotted giving birth and resting from 10 am to 2 pm at a 10-kilometer stretch of Playa Limón on the East Coast near Miches. The area is not inhabited and is known for its tranquility. Lorenzo Jesus Aquino of the Committee Pro Tourism and Conservation of Natural Resources of Miches (Conatura) urged government attention to protect the manatees. Manatees are a species in danger of extinction. The Navy is patrolling the area, but Conatura urged more participation from the experts at the National Aquarium, National Parks and Museum of Natural History to study the phenomenon and protect the manatees. Manatees are threatened with accidental capture by fishermen, human predators, or clashes with motorized boats.
7. Poverty is poverty
The Listin Diario newspaper reports that 20% of the children under 14 years of age in the mountain valley farming communities of Constanza have not been officially declared. Pro-Joven coordinator Karen Ovalles said that when carrying out a program to combat child labor they counted 3,895 undeclared children. She said that most of the children do not have birth certificates because of the lack of awareness of their parents that live in poverty. She said that they later researched other rural community and found a similar pattern among the rural poor, regardless of them being children of indigent Haitians or Dominicans. She now estimates a third of the children in rural areas do not have birth certificates. In the DR parents have a month to declare the children. If this is not done so during that time, the process requires many more steps. Public hospitals in major cities will issue birth certificates to children born there, which has resulted in a decline in the number of undoc!
umented children in urban areas.
49. Trucks banned over Chavón river bridge
La Altagracia governor Pedro Rojas Morillos announced that since last Friday trucks and heavy transport equipment are banned from using the bridge over the Chavón River (La Represa). Several accidents have occurred when trucks heavily loaded with cargo have not been able to make it up the hill that crosses the river on the Higuey-La Romana highway. Trucks will now have to detour and use the Carretera Mella that leads to El Seibo.
