EVERY week a new dispute over the implementation of the national health scheme (Gesy) emerges. This week it was the turn of the Association of Insurance Companies (Saek) to complain about the plan to have a single-payer health care system administered by the Health Insurance Organisation, a state body.
Like hospital doctors and nurses, insurance companies are looking to cash in on Gesy, but they have an additional reason for their stance. As the scheme stands they would lose a lot of business because 150,000 people are currently covered by health insurance. Many of these customers, who would have a percentage of their salary deducted every month to pay for Gesy, would not want to pay for private health insurance as well.
Saek’s views are shaped by its members’ financial interests, even though it has tried to argue that a multi-payer system would be better for the country, claiming that the proposal “of the business community is feasible and functional”. The proposal “of the politicians is practically impracticable and economically deadlocked”, Saek said in a statement in which it insisted that people should have the right to choose what type of health cover they wanted, instead of “staying forever trapped in a monopoly”.
These sound like rational arguments, but they ignore a very important factor – the tiny size of the population – which would make a multi-payer system more expensive and restrict the quality of the health cover it would offer. This was the line taken by the troika, when it was discussing Gesy, but it was not only the small numbers that were a problem. A report prepared by the World Health Organisation (WHO) three years ago said that the lack of historical medical data (a given) would hamper the efficiency of any multi-payer system in which private insurers competed with each other and the state.
The WHO also highlighted the risk that without medical records private insurers would take only low-risk clients, leaving the old and sick for the state insurer that would then become burdened with increased diagnosis and treatment costs without adequate funds to cover them. Insuring low-risk patients while the state covers the chronically ill and the old would be an ideal scenario for private insurance firms, but not so good for patients or state finances.
It is true that it is difficult to trust a state body to administer efficiently such a complex system, given the record of incompetence and poor management skills of state employees. But a multi-payer scheme is not the answer, even if it would boost insurance firms’ profits. The objective must be to make Gesy work efficiently and serve patients as well as possible, not to improve the financial well-being of health professional and insurance firms. Whether the state will be able to realise this objective is another matter.