The reform, in addition to the PSU, aims to create another plan called the New Associated Plan, intended for new members of the system, coming from the Fundas, or who will start paying for 7% for the first time. This plan will have coverage and limited benefits and will last for two years. That is, after the expiration of that time, the branches will be able to access the PSU. According to health sources, it is a mechanism to prevent the generation of mass migration from the Fonasa of Isaapress or vice versa, which can cause financial destabilization of the system. There are also sectors that question this plan as unconstitutional and discriminatory.
How will the risk factor be determined?
The current Fact Sheet is terminated, a method used to adjust the cost of health plans depending on the risks of their members. In return, the concept of "regulated competition" is proposed, a system used in countries such as the Netherlands, Germany and Belgium. This system includes tools such as a compensation scheme which, according to the law, its "aim will be to alleviate the differences in the costs that different members must take for their health plan." In addition, risk groups are created.
Although today's isapres has a compensation system (included in the GES Plan), it only evaluates gender and age variables without involving health issues.
The reform expands this system to the common use of the benefits that the Single Health Plan (PSU) will have.
The new law also creates a new healthcare technical council that will determine the amount of "solidarity contribution" that will leave 7% of the contribution paid by members over the age of 18 who will be included in the compensation scheme, so that can work With the creation of risk groups, where members will be grouped, depending on their age, sex, health conditions and other variables that will be added to the calculation, will define which groups make more and less the use of benefits; depending on this, the risks of each portfolio will match. Thus, companies with less risky portfolios should transfer resources to those who have the most-used affiliates, which "discourage companies from selecting their affiliates," says David Debrot, a healthcare economist.
Requirements for financial solvency of the Isassays
To ensure the stability of the new system, it will be required to maintain a guarantee "for the amounts received as a result of the solidarity contribution, which is equivalent to the percentage of the said contribution." In addition, they must accredit the minimum capital equivalent to 10 thousand promotional units (UF); a guarantee equivalent to 4000 UF, maintaining equity equal to or greater than 0.3 times the total debt, while their assets may not be less than 10 thousand UF. According to former health chief Sebastian Pavlovic, the new regulation "doubles current requirements and allows them to respond to compensation and makes the system financially sound."
There will be five years for migrating to the new Single Health Plan
Once the law enters into force, which will be one year after its publication in the Official Gazette, it will be able to offer its new members only to the PSU. With this, it is intended to complete, within five years, more than 60 thousand plans of the existing system.
Current isapres subsidiaries, meanwhile, must migrate to the PSU for the same five-year period. Isapres will be obliged to offer the PSU, but may provide complementary benefits in different contracts and whose benefits will not be affected by the compensation system. Izapress said that this obligation to migrate to the PSU could generate "enormous" fate.
The Transition Plan "Against Exit"
The isapres reform recognized this week by Congress establishes a new Single Health Plan (PSU), with coverage of 80% in all the attention in the network of preferred services. The rejection will be voluntary and will set a maximum amount of costs outside your pocket to protect your members.
Technical Council for Health
The initiative aims to create a six-member Technical Council on Health, whose functions will be to propose the benefits and costs of the PSU, in addition to the tariffs for the mentioned benefits, the amount of solidarity contribution, the establishment of remuneration groups and the calculation rules for benefits for solidarity. While proposing all these changes, the ministries of health and finance will assess the proposals that will be implemented. This has created uncertainty in the industry, given that some actors expect their resolutions to be binding and their autonomous work, the authorities and governments in return.