With Tornado in the hand and mind in the pocket

A dentists are better off to repair a tooth extractions. Dentists warn that the prepaid policies can lead to a true "dental devastation." If the dentist detect a cavity in the same piece that repaired a year ago, it is possible that the provider - the company prepaid medical or social work - do not recognize the coverage. If you have to extract the tooth where a year ago another professional did a root canal, the first will be deducted from what he perceived the benefit. "Therefore, the dentist finds it safer to do the extraction, a practice will receive a low income but surely, because it never granted," says the secretary of the Federation of Dentists of the City of Buenos Aires (FOCIBA) Hector Ziegler. The supply and demand policies that govern health insurance plans, and are not subject to any official control, can lead to a real dental devastation, taking into account income prosthesis usually bring with extractions, say the experts consulted by Página/12.

For FOCIBA president, Rubén Pérez Goette, the source of the problem is "outsourcing" of services provided by the prepaid and social works, mechanism booming over the last decade. "Companies do not hire dentists but other companies that pay you a head by the number of members, and these are the ones responsible for making a booklet, hiring providers," says professional.

In these contracts, companies impose a sort of "guarantee" for the dentist's work, which can vary, as appropriate, between one and three years. "For periodontal treatment - a case of pyorrhea, for example - firms impose a three-year warranty," says Isaac Rapaport, chairman until a few months of the Ateneo Argentino of Dentistry. "Then, if the disease returns, which in many cases can occur, the contractor shall do your work for free, without charge weight," says professional.

The same goes for root canal treatment. "In general are going well, but if not accompanied by a prosthetic pin and crown, it is possible that six months after the piece is split and has to do the extraction. In this case, the dentist will be debited at that income through, "said Rapaport.

Worse is the case of caries. Companies recognize that a piece has already been repaired although the treatment was made on only one side of the tooth. "If another injury to another side of the same piece - very common, experts say - the prepaid will not recognize it," Ziegler said, pointing with a pen the five visible surfaces of a tooth that may be affected by caries.

"The written and oral contracts made by firms require professionals to carry out their lists devastating dentistry, while prevention is ruled out," says Horacio Martinez, a dentist and director of the Dental Universe magazine. "How the capitation they receive are low - do not reach the two dollars per month per member - care clinics discourage beneficiaries," says Martinez.

The benefit for employers is twofold: "They spend less money than the fixed fee and have received more profit by placing false teeth," says Martinez. "Some clinics - add - reward their dentists with 50 percent of the value of the implants to be made edentulous patients for them."

"A contract made with the dentists are not regulated by any standards, only by the laws of supply and demand," complains Ziegler. "The direct consequence of this state of affairs is the practice of prostitution," says Rapaport. And he cites: "In places where the professional production and get paid for serving on 15 minutes when it should take 40, the treatment can not be done with all care. And it hurts the patient."

The logic of the system does not allow complaints of any kind. "If a professional protest, it will show the stack of applications for dentists on the waiting list for hire, or direct him out of the riot," said Ziegler.

The companies gave their version. For Rolando Gutesman, auditor of Dental Unified System, "the professionals have had to convert: no longer an island and now the system does not deal with dental or social work, is doomed to not work." Recognizes that the system is more thought on profitability in the patient's health, but says, "is something we do from this company can not change." "For the greed of the market, capitation increasingly are lower - Gutesman complains - the networks are scrambling to cut prices." On the form of guarantees, explained that based on "the statistical concept of doing the same service twice."

Rapaport argues that "has been proposed to the companies to consult with specialists at the highest level to see if it is reasonable to demand a guarantee, but we did not succeed." "We agree that companies do audits for which benefits are not paid more, but on condition that it be made with commercial interests and honorably pay the professionals," concluded the expert.

Thinking to cut costs

"The problem of dentistry is no stranger to medicine in general: the growth cycle of intermediation involves a waste, because money that should go to services is of such groups as profit," says Aldo Neri sanitarian doctor. The model applies to both social work and that of private health insurance plans. "The difference is that on social work there is some regulation in the prepaid does not exist, because Congress has not enacted the relevant legislation," says the specialist.

The Argentine model tends to resemble the U.S., "the worst in the developed world, where he spends much and badly, because there is an excess of benefits, consumer goods also pervades medicine." "The difference is that here you can consume more pay a higher fee, while the rest is under-consumption," the sanitarian.

Neri, former health minister and member of the Alliance Programmatic, argues that the absence of the state, and supply and demand as the only regulation leads to "get off the value of capita cost of the work of professional and service people receive. " "It's a model designed to lower costs with lower quality services," he concludes.