pacientes obras socialesEl Gobierno envió al Congreso un proyecto de ley que crea una agencia para limitar tratamientos médicos, tecnología sanitaria y medicamentos obligatorios que deben porveer las prestadoras.

El Gobierno impulsa en el Congreso un cepo a los juicios contra obras sociales y prepagas que prevé una sustancial reducción de costos en el sistema.

A pedido de sindicalistas y empresarios, el Ejecutivo envió un proyecto de ley para crear un organismo encargado de fijar límites en tratamientos médicos, tecnologías sanitarias y drogas de provisión obligatoria por parte de las prestadoras.

En la actividad estiman que los amparos de afiliados que exigen coberturas no previstas representan por lo menos un costo adicional del 10% en el sistema.

El Gobierno impulsa en el Congreso un cepo a los juicios contra obras sociales y prepagas que prevé una sustancial reducción de costos en el sistema. A pedido de sindicalistas y empresarios envió un proyecto de ley para crear un organismo encargado de fijar límites en tratamientos médicos, tecnologías sanitarias y drogas de provisión obligatoria por parte de las prestadoras. En la actividad estiman que los amparos de afiliados que exigen coberturas no previstas representan por lo menos un costo adicional de 10% en el sistema.

La creación de una Agencia de Evaluación de Tecnología, contenida en una iniciativa que el Ejecutivo envió para su debate parlamentario, responde a un reclamo de años de gremialistas y ejecutivos de la medicina privada. Se trata de un ente ideado para analizar el “costo efectividad” de nuevas prestaciones, medicamentos o procedimientos de diagnóstico lanzados al mercado y cuya cobertura no está prevista por los efectores de salud, aunque corren el riesgo de afrontarla a partir de decisiones judiciales.

La iniciativa, a cargo del Ministerio de Salud, busca ponerle un freno a la facultad de jueces de ordenar amparos a favor de pacientes que exigen para sus dolencias ser tratados con técnicas o drogas no incluidas en el Programa Médico Obligatorio (PMO). En general las controversias surgen por novedades tecnológicas o bien, por prestaciones que a pesar de existir en el mercado a precios más accesibles terminan por ser recetadas o exigidas en sus versiones más costosas.

“La creación de una Agencia de Evaluación de Tecnologías nos parece, desde el movimiento obrero, una iniciativa muy importante para controlar los costos en materia de atención médica y utilizar recursos con racionalidad”, le dijo a este diario José Luis Lingeri, secretario de Acción Social de una de las CGT. El dirigente destacó que “la Justicia, vía amparos” obligó a las prestadoras de los gremios a “cubrir por fuera del PMO tecnologías sin evidencia de su utilidad”.

En la misma línea opinó Claudio Belocopitt, presidente de Swiss Medical Group y portavoz habitual de las prepagas: “La Agencia existe en muchos países del mundo y es una necesidad imperiosa del sistema. Es fundamental no sólo para el presente sino para el futuro. Todos los días proliferan nuevas prácticas y no siempre está probado que den resultado. Se han producido disparates como jueces que aprueban tratamientos con drogas experimentales que en Estados Unidos todavía no fueron aprobadas”, alegó.

Para el empresario “la plata en el sistema de salud no alcanza y cada vez va a alcanzar menos” y “más de 10% del costo se lo llevan estos juicios”, lo que a su criterio impone la creación de “un organismo independiente, gubernamental y con profesionales de máximo nivel” para fijar los límites. Incluso admitió que podría abaratar los costos de los planes que ofrecen las empresas a sus afiliados. También coincidió con la necesidad de crear la agencia Alejandro Collia, exministro de Salud bonaerense y en la actualidad secretario del área en La Matanza: “Es indispensable para evaluar la relación costo y beneficio de las nuevas tecnologías y optimizar los recursos”, indicó.

 

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