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Mandatory prices for medical procedures rankle public, politicians

The latest salvos were fired last week in a national furor over the attempt to set minimum prices for all medical procedures performed by private practitioners in Costa Rica.

On June 27, a consumer group filed a complaint with the Constitutional Chamber of the Supreme Court, or Sala IV, over the medical price floors, which were set by the Costa Rican Doctors’ and Surgeons’ Association in May.

And on Thursday, Christian Democratic Alliance lawmaker Mario Redondo presented a bill in the Legislative Assembly that would ban all professional associations from setting mandatory price floors.

For the past two months, patients, politicians and public health officials have been weighing in — many of them angrily — on the decree passed by the Doctors’ Association, the country’s official medical licensing entity. The decree establishes minimum fees for everything from basic exams to major brain surgery.

Many say the proposed prices for some procedures are much higher than current rates, and they’re concerned that a spike in prices for private medical care could push up insurance costs and force more patients to rely on public hospitals, overwhelming already strained resources.

The 217-page list detailing more than 9,000 medical procedures and their accompanying minimum fees includes everything from a basic mammogram, ₡15,000 ($27), to surgery to repair a cerebral aneurysm, ₡20 million ($36,600).

The price for stitching up a gash up to 2.5 centimeters (1 inch) long on the head, torso, legs or arms would cost ₡210,990 ($380). The same procedure would cost up to ₡703,300 ($1,270) if the wound is bigger than 30 cm (1 foot). (See the full price list below.)

Consumer groups claim the fees for some procedures represent increases up to 300 percent.

Alexis Castillo, president of the Doctors’ and Surgeons’ Association, disputed that assertion in a public statement, arguing that any price comparison is irrelevant since this is the country’s first official price list for medical procedures.

Castillo said the proposed prices were derived from research conducted over the past five years. The Doctors’ Association compiled price data from each medical specialty offered in Costa Rica. It also took into account the complexity of each procedure, how often a procedure is performed and the number of specialists who perform it, among other factors.

Castillo said the list would allow consumers to keep a better watch on their medical bills and give them a tool to denounce abusive costs.

The decree approving the price list was published in the official newspaper La Gaceta on May 2, which means it’s technically applicable. But the Doctors’ Association suspended enforcement of the new minimum fees until September in order to hear concerns voiced by the public, insurance companies and public officials.

Rush on public health services?

Health Minister Fernando Llorca said the new prices would force a large segment of the population to seek attention at hospitals and clinics of the Costa Rican Social Security System, or Caja, straining the public health system and taking away business from private doctors.

Llorca recently met with the Doctors’ Association and asked it to reanalyze the fees and “come up with a list of prices in line with the country’s situation and the citizens’ ability to pay.”

Caja executive president María del Rocío Sáenz said in a public statement that she will wait to see whether the Doctors’ Association issues a revised version of the price list in September before opining on the possible effects on the Caja.

“Initially, I think the main impact would be a possible migration of patients from private practice to public hospitals,” Sáenz said, adding that it could also cause a migration of physicians from public hospitals to private practice, attracted by a potentially higher income.

Elián Villegas Valverde, president of the National Insurance Institute (INS), which issues mandatory workers’ insurance and private policies, said the proposed minimum prices would increase INS medical costs up to 75 percent and therefore policy premiums could rise up to 89 percent.

“That means we will likely see a decrease in the number of people holding an insurance policy and those people will likely begin demanding more services from Caja’s hospitals,” Villegas told lawmakers.

The Ombudsman’s Office also weighed in on the medical price floors, saying they would have serious economic and social consequences for the population. Deputy Ombudsman Juan Manuel Cordero sent the Doctors’ Association a letter asking whether the group had evaluated the potential impact of the new prices on the population before signing them into a decree.

Citizen action, political opposition

Last Monday, the Costa Rican Free Consumers Association filed a complaint with the Constitutional Chamber of the Supreme Court, or Sala IV, arguing that setting price floors violates Article 46 of the Constitution, which guarantees citizens’ rights to economic security and health.

The complaint also argues that the Doctors’ Association should have held a public hearing about the proposed prices, and should have consulted with the Health Ministry.

Assemblyman Redondo, who chairs the legislative Committee on Public Income and Spending Control, said he’s confident that his bill intended to quash the mandatory minimum prices has solid support in the legislature.

The bill is co-sponsored by an unusually diverse coalition of lawmakers, including Epsy Campbell and Ottón Solís from the ruling Citizen Action Party, Otto Guevara from the Libertarian Movement, Julio Rojas from the National Liberation Party and Jorge Arguedas from the Broad Front Party.

Besides the social and economic implications, Redondo questioned the legality of the minimum price list. For one thing, he said the approved list includes procedures that are generally performed by nursing assistants or X-ray technicians, not doctors and surgeons.

“They even set a price for setting an intravenous drip,” Redondo noted.

He also said the decree should require ratification by the president, which has not occurred.

Redondo’s bill has just two articles, which would reform Costa Rica’s consumer defense law. The first article would prohibit all professional associations from setting mandatory minimum prices, though they would be allowed to establish suggested prices.

The second article establishes a monetary fine of up to ₡42 million ($76,500), equivalent to 100 monthly minimum salaries, for any professional association that fails to comply.

See the full 217-page list of medical procedures and their minimum price (in Spanish):

Contact L. Arias at larias@ticotimes.net

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