Government wants to avoid being health care ‘provider of last resort’

Aug 7, 2016 | 6 comments

Proposed legislation that would require health insurance companies and pre-paid health plans to provide coverage for congenital diseases as well as pre-existing, catastrophic and chronic conditions is not just about eliminating discrimination. It is also about protecting Ecuador’s Social Security and public health system.

Costs for catastrophic medical care are are issue of new law.

Costs for catastrophic medical care are are issue of new law.

“We don’t want public health services to become the provider of last resort,” says Pamela Falconi, one of the sponsors of the bill. “Private providers must share this responsibility and this burden. We all understand that these services are expensive.”

Private insurers say that their viability depends on a broad customer base with a range of health needs. “If we are required to cover more clients with severe conditions our costs will rise,” says Eduardo Izurieta, president of the Association of Prepaid Medicine. The choice for us will be to increase premiums or go out of business,” he says.

Under the current law, adopted in 1998, insurers can refuse to provide or drop coverage for patients for a variety of reasons described in the policy. Among these are age, chronic, congenital and hereditary diseases, and pre-exisiting conditions.

Falconi says those who offer private health services have a moral obligation to cover all customers that they accept. She concedes that price for services may need to increase.

Most private coverage in Ecuador is for workers under company health plans. As of 2015, 987,297 were covered through insurance and pre-paid plans by 24 providers.

Private health providers oppose the proposed legislation as it is currently written. “These blanket changes put our industry at risk,” Izurieta says. “We are working with the Assembly and hope that they are considering our advice. I understand the situation with the government but our interests are similar. It is very expensive to cover the sickest people and there is room for discussion on the point. We understand the cost must be shared.”

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