Social Security health program adds new criteria for care; says changes are necessary to curb abuses in the system

IESS’s Hugo Villacrés

Ecuador’s social security health care system has revised its procedures to lower costs and eliminate what it says have been abuses of its services.

The major change, according to social security system director (IESS) Hugo Villacrés is the reduction in referrals to private health care providers. In the past, he says, members of the social security plan were usually able to receive care at the private hospital or clinic of their choice.

“There has been some bad faith shown by some members of the system so we are forced to reevaluate our operations, especially at it relates to referrals,” Villacrés says. He added that most of the abuses were by members who joined the system only to take advantage of services for expensive health services, such as surgery, and those who also have private insurance and decided to use IESS because of lower costs.

According to Villacrés, the primary effect of system changes will be to keep patients in the IESS system and reduce referrals to private providers. Villacrés says that, in cases of emergency, IESS members will still be able to use private services.

In addition to lowering referrals outside the IESS system, the new criteria will consider the patient’s proximity to IESS facilities and income. They will involve a check to see if patients have private insurance and, in some cases, require that private insurance pay for services.

During his November 8 weekly television broadcast, President Rafael Correa said that the IESS system was being abused by those who can afford to pay more for health care and said he had ordered an evaluation of procedures. “If we cannot eliminate the abuse of our system, will be forced to consider major changes,” Correa said.