The National Social Works System is made up of trade union social works (for workers and their families covered by collective work agreements) and social management social works (for executives, professionals and workers not covered by collective agreements). Originally affiliation was compulsive to the social work of the sector. In the 90s’ the free choice between social works was established. This gave rise to the Prepaids made agreements with some social works so that the affiliates of higher income derive their contribution to them in exchange for the payment of a commission to the derivative social work. This is known as “derivation of contributions.”
Last year the entrance of the prepaids to the National Social Works System was enabled. That is, they can now choose to receive contributions without the intermediation of a social work. However, with a strange legal instrument (resolution 1/2025 of the Cabinet Unit of Advisors of the Ministry of Health) it was arranged that the affiliates that derive contributions have to send them directly to the prepaid, or, stay in the derivative social work and Receive medical services from it. I mean, The advisors of the Ministry of Health prohibit “derivation of contributions”.
How many people affect this new disposition? It can be estimated, with information from the 2010 census, that the composition of the affiliation to social works is as follows:
-In the national social works there are approximately 13 million members.
-Some 4.2 million They derive their contribution to a prepaid.
-The remaining 8.8 million Affiliates do not derive contributions.
These data show that The people involved in the derivation of contributions represent a third of the total affiliates to national social works. Government coercion implies a very massive change with the risk of generating serious disruptions in the functioning of private medicine. In this sense, it is very suggestive that both the Minister of Health and the Superintendent of Health Services, a regulatory entity of social works and prepaid, excused themselves from signing the norm and had to appeal to the advisors of the Ministry of Health. An improvisation that will surely be questioned in its legality.
One of the main problems of the social works system is that It is forced to provide the same provision package (mandatory medical program, PMO) to people with very different levels of contributions. This leads to sub-financial families, that is, with their contributions it is impossible to finance the PMO. In this framework of financial inconsistency, the derivative social works meet a fundamental role. They allow families with sufficient income to access a prepaid, while sub-financial families remain in social works with partial access to the PMO and often attended in public hospitals. Prohibit the derivation of contributions so that all families choose a prepaid directly, not only is it questionable from the legal point of view, but will aggravate the financing crisis suffered by private medicine.
To improve the functioning of the social works system, the contributions of sub-financial families must be increased. If all families were reasonably financed, prepaids would not need the services of the derivative social work since they could directly attend to all families. This problem can be corrected, at no fiscal cost, assigning 100% of the solidarity of redistribution (FSR) to strengthen the contributions of lower income families. Distributing the FSR automatically to increase the lowest contributions is a criterion overcoming to the current use that subsidizes social works with discretionary and prebendary criteria. Focusing 100% of the FSR in lower income families is a much more consistent policy with solidarity and freedom.
In parallel, It is very important to order the PMO eliminating benefits that are not medical care. For example, social services for disability, addictions, family accompaniments or the financing of innovation in medicines that are very high cost. All these benefits, currently incorporated into the PMO, should be in charge of other State agencies such as in well -organized countries.
By Jorge Colina
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