Family doctors accuse the CNAS of not paying their services in full for the month of October: “Payment in the proportion of 60-70% – unacceptable”

Family doctors accuse the CNAS of not paying their services in full for the month of October: "Payment in the proportion of 60-70% - unacceptable"

​Several employer organizations of family doctors affirm that the contractual deadline for full payment of primary medicine services in October is not respected by the Health Insurance Funds: “Partial payment, in the proportion of 60-70%, is unacceptable, this clause not being included in the bilateral contract assumed”, affirm the representatives of family doctors, showing that if measures are not taken within two days, family doctors will suspend all programmable medical activity.

To the doctorPhoto: Wutthichai Luemuang | Dreamstime.com

Due to the insufficient budget and the lack of budgetary recovery, the National Health Insurance Fund has been without money since the beginning of autumn and has accumulated debts to medical service providers in recent months – hospitals, medical offices, pharmacies and analysis laboratories.

The President of the National Health Insurance Fund, Andrei Baciu, said a week ago that the CNAS requested 4.2 billion lei and received only 1.7 billion from the Government Reserve Fund, money which will be allocated, first and foremost, to employee salaries, the rest will be distributed equally to the areas of medical assistance.

The employers’ organizations of family doctors draw attention, in a press release, to the departmental health insurance funds and the CNAS to the fact that the contractual deadline for full payment of primary medicine services provided in October 2023 is not respected.

“This fact represents a unilateral violation of the contract for the provision of medical services which may generate damages. We believe that compliance with contractual provisions must be an obligation of all parties signing a contract and not only medical service providers . A partial payment, in the proportion of 60 to 70%, is unacceptable, this clause not being included in the presumed bilateral contract. You will have to quickly provide public explanations to the legal entities that we represent and whose forecasts you have upset regarding the repeated non-compliance of health centers with contractual provisions”, say the organizations of family doctors, cited by News.ro.

According to them, this is not an isolated incident, there was previously a payment delay of around 14 days: “We say publicly that patients who cannot benefit from their own health insurance are strictly under your responsibility. We suggest that you explain to your insured what the consequences of not providing medical services in primary care may be. We urgently ask the CNAS and the CJAS to pay attention to this problem and find immediate solutions to ensure the correct and punctual payment of medical services provided by family doctors so as not to create financial difficulties for healthcare professionals. sector. It is crucial to avoid any negative impact on patients’ access to quality primary medical care,” family doctor representatives also say.

They add that, within two days, in the absence of measures to remedy the reported problems, they will suspend all programmable medical activity.

The press release is signed by the Employers’ Organization of Family Doctors of Bihor, the Association of Family Doctors of Bistrita-Năsăud, the Association of Family Doctors of Bucharest-Ilfov, the Association of Family Doctors of Cluj, the Association of Family Doctors of Dâmboviţa, the Association of Family Doctors of Dolj, the Galaţi Family, Association of Family Doctors of Gorj, Association of Family Doctors of Iaşi, Association of Family Doctors of Mureş, Association of family doctors of Sibiu, Association of Family Doctors of Timiş, Association of Family Doctors of Vâlcea, Association of Family Doctors of Vrancea.

Rafila affirms that the CNAS budget will be regularly supplemented

The Minister of Health, Alexandru Rafila, said that the CNAS budget will be regularly supplemented, so that by the end of the year, the necessary funds for medical services are assured.

At the same time, he declared on Monday, for B1Tv, that the budget of the National Health Insurance Fund had been supplemented by 1.7 billion lei, while the CNAS had requested 4.2 billion, because it was based on the availability of the state budget at the time. respectively.

“From the discussions I have had at government level – I also discussed with the president of CNAS, Dr Baciu – I understand that these supplements will be sequential, repeated, so that at the end of the “year they will ensure full financing of services, both in hospitals and for medicines and paid and free health programs. Of course, you can adopt decisions aimed at supplementing the budget from the reserve fund available to the government or from other sources, on several occasions; even if these supplements are more frequent and the end result is the same from the point of view of covering the necessary sums, then I think that things will follow their normal course”, declared Rafila, quoted by Agerpres.

The Minister of Health also said that the CNAS finances hospitals based on the contracts concluded and that the allocation of 1.7 billion lei will reach the medical units these days. He mentioned having had discussions with the Ministry of Finance and the CNAS and declared himself convinced that budgetary corrections will continue, so that “the impossibility of providing” medical services is not reached. At the same time, he admitted that recently the costs associated with medical equipment, medicines and utilities have increased significantly.

“We must understand that, even if hospitals do their indicators, that is, they do all the consultations that they have contracted, the amounts they receive are not sufficient. We are trying to elaborate a concrete proposal, so that together with the CNAS we can propose solutions to be implemented in the next period, on the one hand. On the other hand, the way of financing medical services next year should change and reflect reality. Because if I receive an income of 100 lei and my expenses to obtain this income amount to 120 lei, it is clear that there is no financial viability. This difference must be made up by changing the way hospitals are financed. Probably, medical services that for eight years have not changed in terms of value – only this year they have changed by 13.2%, the rate of inflation – need to be reevaluated and it requires a time interval,” Rafila said.

Photo: Dreamstime.com.

Chkayer

Chkayer

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