Doctors' outcry against insurers: "very bad" rates and an unsustainable 'low cost' model

PalmThe Official College of Physicians of the Balearic Islands (COMIB) has published a study on the state of private healthcare in the Balearic Islands, which reveals a persistent discontent among professionals in the sector. According to the organization's president, Carles Recasens, the initiative arose from complaints that doctors working in the private sector have been making for a long time regarding the conditions and treatment they receive from insurance companies. In the Balearic Islands, there are approximately 3,000 doctors working in private healthcare, a figure that represents nearly 50% of the medical community. The survey conducted by COMIB was answered by 236 members. Of these, only 9 practice exclusively in the public healthcare system; 111 offer mixed care—public and private—and 111 work solely in the private sector. The results paint a clear picture: 123 of those surveyed believe that the private healthcare system is not sustainable under the current conditions. 90% say that insurance companies do not promote quality of care; 87% rate the applied rates as bad or very bad; 85% denounce the negative impact of the model low cost77.9% reported being dissatisfied or very dissatisfied with the situation. None of the participants rated the doctor-insurer relationship as sufficient.

According to Recasens, the discontent stems primarily from a loss of independence and professional autonomy, as well as remuneration that many doctors consider "undignified and meager." Consultation fees can range from 8 to 14 euros, depending on the institution and the procedure. "People pay more for television service," the president of the COMIB (Official College of Physicians of the Balearic Islands) compared, to highlight what he considers a devaluation of the medical profession.

From liberal profession to dependent model

The College maintains that the medical profession, traditionally a liberal profession—like that of lawyers—has been transformed into an activity dependent on large hospital groups and insurance companies. While previously doctors could negotiate with which entities they worked, now, according to Recasens, "it is the insurance company that dictates the fee schedules, what to do, and with what equipment." The payment system is based on billing per procedure: the doctor bills the insurance company, but currently does so through hospital corporations, whereas before the relationship was direct. This change, according to the COMIB (Official College of Physicians of the Balearic Islands), has reduced individual negotiating power and consolidated a model in which conditions are dictated by large corporate structures. Furthermore, the patient is bound to the network of doctors established by the insurance company, limiting their actual ability to choose and reinforcing the central role of these entities in organizing healthcare. Regarding the evaluation of the companies, Sanitas is the insurer most highly regarded by those surveyed, followed distantly by Axa. On the other hand, Asisa is by far the worst rated, followed by Adeslas.

One of the central points of criticism is the expansion of policies low costWith low prices that, according to the College, do not reflect the true cost of quality care. 85% of the doctors surveyed believe this model has a negative impact. Recasens warned that many of these policies offer basic coverage and can generate expectations that later do not correspond to the reality of care. "What people contract directly affects their health," he emphasized. The study also points out that waiting lists, which for years were mainly associated with public healthcare, have spread to the private sector. Specialties such as Gastroenterology and Gynecology are experiencing delays, and it is increasingly common for insured patients to have to wait to see a specialist. According to the COMIB (Official College of Physicians of the Balearic Islands), this demonstrates a structural strain that is not exclusive to any one specific entity, but rather affects the entire sector. The College identifies several risks stemming from the current situation. First, an increase in pressure on the public healthcare system if the private sector loses its capacity to resolve cases. Secondly, the configuration of a low-resolution private sector that refers the most complex cases to the IB-Salut (Balearic Islands Health Service). It also warns of the difficulty in retaining medical talent in the Balearic Islands if economic and professional conditions do not improve. Furthermore, the COMIB (Official College of Physicians of the Balearic Islands) warns of potential risks to patient safety if consultation times are insufficient or if the organization of care is excessively driven by economic criteria.

Coexistence of models

Recasens argued that private and public healthcare coexist and that "good private healthcare helps public healthcare and vice versa." Although they compete in certain areas, "both systems complement each other," he asserted. In this regard, he warned that if the private sector has structural problems, this ends up generating greater strain on the already overburdened public healthcare system. Given this scenario, the COMIB (Official College of Physicians of the Balearic Islands) is calling for an annual update of fee schedules linked to the Consumer Price Index (CPI) and the complexity of care, as well as a reduction in bureaucracy and a streamlining of clinical authorizations. The College is committed to opening negotiations with insurance companies and large hospital groups to address these issues. "The College represents all doctors, both public and private," Recasens emphasized, adding that the negotiation is not just a labor issue, but rather "lays the foundation for the future of healthcare." The conclusion was that the organization has a duty to defend the interests of healthcare professionals, but also those of patients and the overall sustainability of the Balearic healthcare system.