The need to guarantee fast, safe health care and reduce the primary health services, such as hospitalizations, medical consultation, treatments, and tests, has led citizens to contract out of obligation or private or public health insurance is mandated by law.
Although Law 87-01, which creates the Dominican Social Security System (SDSS), obliges the employer to grant the employee a primary health plan in any health risk administrator (ARS), no regulation requires the clinics to serve under that plan.
Currently, having health insurance is synonymous with savings and investment. The cost of the medical consultation with basic insurance from six centers investigated by el dinero presents a difference of up to RD$300.
But not all clinics accept basic insurance. They do not provide coverage with this plan. The medical consultation ranges between RD$3,000 and RD$6,000.
The difference in prices of the medical consultation
The difference that patients pay for medical consultation depends on the health center and their insurance.
According to the survey on the price of medical consultations, the Abel González clinic is the most expensive. Specialists do not accept basic insurance. However, they do take international insurance such as World Wine and BMI. The consultation price ranges from RD$1,000 to RD$6,000.
This is followed by the Corazones Unidos clinic, where consultations cost between RD$3,500 and RD$5,000 (in this case, only urologists accept basic insurance with a difference of RD$1,000).
In Gynecology and Obstetrics, specialists accept basic insurance with a difference of RD$1,000, while without medical insurance, it ranges between RD$2,000 and RD$4,500.
The Modern Medical Center is where the consulted specialists accept basic insurance. Here the difference is RD$700 and RD$1,000.
In hospitals, they do not consult with basic insurance. They only accept complimentary plans—consultations with insurance range between RD$300 and RD$500 and private ones at RD$3,000.
The Center for Diagnosis and Advanced Medicine and Medical Conferences and Telemedicine (Cedimat) was the only one that did not offer data on the difference in consultations. According to customer service, the cost is reported to the patient when she comes for consultation. In this center, the talk without any specialist insurance is RD$2,000.
Services
According to the financial statistics of the ARS members of the Dominican Association of Risk Administrators (ADARS), they had 2015 profits amounting to RD$775 million.
The income of the administrators amounted to RD$35,782 million, while the costs for payment to the service provider centers reached RD$29,734 million. The ARS allocated RD$3,474 million to administrative expenses, RD$1,589 million to promoter commissions, and RD$208 million to the payment of Income Tax.
Health services ARS affiliated with ADARS increased 2.38%, from 39,459,110 in 2014 to 40,401,505 in 2015.
The difference that patients pay for medical consultation depends on the health center and their insurance.
The amount paid for health services provided by the ARS of ADARS presented an increase of 9.35%, going from RD$27,191 million in 2014 to RD$29,734 million in 2015.
According to the ADARS financial report, the only line that decreased income was average and diagnostic laboratories, going from RD$18,101,204 in 2014 to RD$16,228,652 in 2015.
About Law 87-01 and the ADARS
Law 87-01 aims to establish the Dominican Social Security System (SDSS) to regulate and develop the reciprocal rights and duties of the State and citizens regarding financing for the protection of the population against the risks of old age, disability, unemployment due to advanced age, survival, illness, maternity, childhood and occupational hazards.
The ADARS integrates seven national private ARS: Human, Palic, Universal, Simag, Yunen, Constitución and Monumental.
According to its website, the objective is to strengthen the links between the associated ARS that can assume and manage the risk of providing the Basic Health Plan to a certain number of beneficiaries through a per capita payment previously established by the Council. National Social Security.
The National Health Insurance (ARS Senasa) and the ARS are the entities authorized by the Superintendence of Health and Labor Risks to assume and manage the risk of the provision of the Basic Health Plan.
