The measure is based on the concept that “health care is a right that is guaranteed by the constitution, and is a public service protected by the state, even when it is provided by the private sector,” according to Nahomi Figuera, the chief public defender for Venezuela’s capital city, Caracas.
The goal of the auditing is to guarantee that people who invest in private health insurance plans receive proper care at nonspeculative prices when needed, “without inconveniences or abuses,” Figuera said.
A 24-hour phone line and an email address were established for patients to file complaints and reports about their experiences with private insurance providers and clinics.
The legal basis of the inspections is the Law on Insurance Activities, which was reformed by the National Assembly earlier this year. The law prohibits the delay of emergency medical care due to paperwork or other insurance-related matters, and places the burden of proof on insurance companies to justify any denial of care based on stringent guidelines.
The three state institutions signed a formal inter-institutional cooperation agreement earlier this month and began with inspections of 40 clinics in metropolitan Caracas, Venezuela’s most populated urban area.
The commission consists of 14 public defenders, an unspecified number of INDEPABIS inspectors, and a “situational room” dedicated to the issue and hosted by the Superintendent of Insurance Activity.
Regulating Private Care
Figuera also explained that as the audits proceed, the commission would develop a protocol for medical treatment to be applied to private health care service providers.
A disputed aspect of the law is whether the private health care sector will eventually fade out and become fully government-managed.
National Assembly Legislator Tirso Silva told the state news agency AVN that the law does not have the intention of threatening the existence of the private health sector.
“What the law does seek, and what this situational room will enforce, is to put a stop to the risk of death among patients whose emergency care was not approved,” said Silva.
Accessible Health Care a Priority
Over the past seven years, the government has built an extensive network of free public health clinics located in both poor and middle class neighborhoods, parallel to already existing public and private health care institutions.
These clinics, which provide treatment to all patients who walk through the doors and distribute generic medicines free of charge, have made primary health care accessible to nearly 100% of the national population.