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The price of surviving -or not- COVID


Peruvian Juan Minaya Bonilla, 65, fell ill with COVID-19 and was admitted to a clinic in Lima. After passing away in June, his daughter, Jacqueline, received a bill of about 50,000 soles (about $ 14,200), in addition to the 97,000 soles (about $ 28,000), which he had already paid.

“I had to go into debt, lend money,” Jacqueline tells Efe, who explains that they did not go to a clinic because they wanted “privileged care”, but rather they did it after “visiting all the Social Security (EsSalud) hospitals” and not finding a bed, when his father was already lacking oxygen.

The story of Jacqueline and her father illustrates yet another facet of the pandemic and highlights the harsh consequences that many suffer in countries with more liberalized health systems, where suffering from the coronavirus is compounded by financial hardship.

THE INFRA-FINANCING OF THE PERUVIAN SYSTEM

Peru, the sixth country in the world with the highest number of confirmed COVID-19 infections, faced the start of the pandemic with an agonizing public health system that ensured just 100 ICU beds with mechanical ventilators, for its nearly 33 million inhabitants .

The Government established the national confinement on March 16, in the middle of the race against the virus to equip itself with more ventilators.

Despite the strict quarantine, the numbers of infections continued to increase: The scenes of pain due to lack of attention in the Emergencies occupied the grid of the news. In addition to ventilators, hospital beds, chairs in emergency rooms and oxygen were beginning to be lacking.

It was under these conditions that Jacqueline could not find a bed for her father, who was finally admitted for 22 days to the Jesús del Norte clinic in Lima, until he died on June 30, after which it was revealed that only pharmacy expenses were overvalued in 38,442 soles (about $ 11,000), and that his case was not the only one.

In addition to the overestimation of prices, private clinics have also been denounced for lack of care or negligence, as Atenas Yactayo complains about what happened to her father, Walter Yactayo, a 65-year-old taxi driver who died after 14 days in hospital.

According to Yactayo, his father entered the Jesús del Norte clinic on Friday, June 13, with a saturation that was around 95% oxygen, and that he remained that way the first week, until he began to feel bad about the neglect.

“They allowed him to have his wheelchair, but nobody passed it to him. She had no attention, her bed was wet. She told us I’m cold; He even fell out of bed, “the young university student told Efe, whose family paid 63,000 soles (about $ 17,577) for her father’s care, and after his death, the clinic notified him that he owed 9,000 more soles (about $ 2,511 ).

When the clinic learned that Yactayo had filed a complaint of negligence with the Superintendency of Health, a supervisory body, it offered to “close the case” for a payment of 20,000 soles (about $ 5,580). Yactayo has not accepted the proposal because he wants an investigation into the stressful situation his father experienced, which could have aggravated his health.

In light of these complaints, on June 24, the Government of Peru issued an ultimatum to private clinics to agree on a social fee that would be paid by the State. The figure was set at 50,000 soles (about $ 14,000) for those COVID-19 patients who were referred to private clinics for lack of hospital beds.

INVOICES OF UP TO 22,600 DOLLARS IN CHILE

More than 3,000 kilometers to the south, in Santiago de Chile, Fabián Rodríguez, 40, spent more than three weeks in the ICU of a hospital and now, having recovered, he estimates that he may receive a bill of 80 million Chilean pesos (about $ 101,730).

Rodríguez details to Efe that he is attached to the National Health Fund (Fonasa), which is the public health system in Chile, but when he went to be treated, he was not considered a priority to be treated immediately and, when he was ill, he decided to go to a clinic of the private system, made up of 12 Pension Health Institutions (Isapres).

In Chile, bills for being hospitalized in a public center due to COVID-19 can vary between 1.2 and 18 million pesos (between 1,500 and 22,600 dollars, approximately), depending on the treatment required by the patient .

The people attached to Fonasa may be exempt from paying these bills, depending on age and income (about 10 million people in the country, according to sources from that institution), while the rest of the public health affiliates have a copayment that can be 10% or 20% of those amounts, although there are forgiveness options proving a certain socioeconomic situation.

For other types of conditions, if a person attached to Fonasa goes to a private center, the value of the care will depend on the agreement that center has with public health. In this case, health problems that involve a high cost have a coverage of between 7% and 15% by Fonasa, while the patient pays the rest.

However, this changed in May for COVID-19 cases, and if a member of Fonasa cannot be treated at their public referral hospital and goes to a private center, the cost will be the same as if they had been treated in the public network.

Finally, the values ​​of hospitalization for COVID-19 in private centers for Isapres affiliates vary according to the plan that each person has contracted, in cases of bills of more than 90 million pesos (about 113,300 dollars), others of 60 million pesos (about $ 75,500) and also 30 million pesos (about $ 37,700) and down.

“I went to the public hospital, but they did not want to receive me,” says Rodríguez, who, however, considers that it was “a good decision” to then go to a private clinic, despite the high bill that may reach him, since he was very ill.

“I was wrong. In fact, my wife was warned to prepare for the worst because I no longer reacted, ”recalls Rodríguez, whose body did not respond to mechanical ventilation, intubation and tracheostomy treatments and was on the verge of death on two occasions, while He was in a coma from coronavirus pneumonia.

Rodríguez’s health began to improve only after 2 doses of Tocilizumab, a drug that costs about 1,800,000 Chilean pesos (almost $ 2,300) to dose.

At the time of being admitted to the private clinic, Rodríguez was not protected under the Emergency Law, which presupposes that a person at serious risk goes to the closest center, whether private or public, where they have the duty to attend to him.

On the contrary, the clinic classified it as a normal admission because Rodríguez “came walking”, he laments.

However, in the final report of his hospitalization, it is registered as covered by the Emergency Law, so Rodríguez hopes that the final bill will not be so high since in that case Fonasa would assume a large part of the cost.

USA GOES TO PUBLIC HEALTH

At the other end of the continent, the United States, which is often cited as an example of the limitations and poor performance of a healthcare system in which the private sector is prevalent, has made an exception with COVID-19 and has become momentarily in a de facto public system.

That has been achieved through two major measures: on the one hand, a $ 100 billion package approved by Congress and signed by President Donald Trump in April that compensates hospitals for any expenses related to COVID tests and treatments. -19 in which they incur.

The measure, therefore, allows people without health insurance who are infected or fear they have contracted coronavirus access to hospitals and private medical services without having to pay a single dollar, since the Government is responsible for the bill.

On the other hand, for those who do have health insurance but who normally also incur expenses for co-payments and other costs set in the terms of each policy, the main insurers in the country decided, at the beginning of the crisis, to exempt all these additional payments for COVID-19-related treatments.

“The bills started coming in, one after another after another, with huge amounts like $ 14,000 here and $ 5,000 there. One of them for more than 100,000 dollars. But the financial responsibility of the patient was always 0. It was a big surprise for me ”, explains to Efe David Lat, who in March contracted the disease and spent 17 days admitted to the hospital.

Lat’s New York-based insurer assumed all the costs of a treatment, which amounted to $ 320,000, including the roughly $ 7,250 that he would normally have had to pay out of pocket for the policy terms.

“I didn’t have to do anything, which is incredible since normally in the processes that affect insurance companies, there is a lot of bureaucracy, but this was automatic,” says Lat, who, yes, had to make sure that all invoices they were explicitly listed as treatment for COVID-19, since otherwise, the policies do not include it.

For the United States, which is in full debate on the health model with prominent politicians such as senator and former presidential candidate Bernie Sanders who are committed to a completely public system, the experience with COVID-19 is proving how the system could evolve in the next years.




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