Day 9! Today we visited an Austral building to discuss prepaid insurance companies, such as the commercial company OMINT, which is a private healthcare plan that is paid out-of-pocket. Other commercial companies include SMG, Medicus, and Galeno. They were created in 1967 as a for-profit payer. They do not own any hospitals, but they pay for care. The Austral medical director spoke to us about 48% of the population utilizing the social healthcare system, with about 7.56 million people enrolled in 2023. Prepaid healthcare systems are considered to have the objective of providing prevention, protection, treatment, and health rehabilitation. There are three types of plans: closed (provider network), open (reimbursement), and integrated hospital plan. The key challenges of prepaid insurance include that it has no breadth of coverage, no coverage limit, litigation risk for coverage, government pressure for fee pricing, and private member capability of affording fee payment. Negotiations need to be made every day in order to find the prime price for insurance due to the constantly fluctuating economy. Private payers (prepagas) pay the insurance plan. This is what funds the private sector, dictating how much money goes into the private sector.
Provider level strengths include high level service delivery and access, high quality healthcare providers, high level health outcomes, high level management, cost efficiency, vertical integration, diversification into new business lines, and innovation. Provider level weaknesses include fragmented information and short operative integration with providers, limited integration with Unions Heath System, low fees to providers, moderate reputation among providers and members, insufficient awareness of healthcare costs among members and providers, and underfunding/low profits.
There was a 200% inflation rate in 2023, but now there is a 30% inflation rate in 2026, meaning that inflation is decreasing. Medical inflation occurs due to new diagnoses, demographic transition, chronic diseases, diseases that cause disability, new laws and regulations, patient demands, and lack of cost awareness.
Prepaid insurance and obras sociales both pay for private care, but they also have differences. Prepaid insurance are private healthcare plans that are paid out-of-pocket, while obras sociales are a slightly different medical coverage that is managed by unions and offered to employees by employers. Union health upgraded plans, such as OSDE, are an example of obras sociales.
