Paraguay Info
Joined: 01 Dec 2006
Posts: 14
Home Country: paraguay
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 Posted: Mon Dec 04, 2006 8:23 am Post subject: HEALTHCARE IN PARAGUAY / PARAGUAY HOSPITAL GUIDE |
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HEALTHCARE IN PARAGUAY
OVERVIEW
Paraguay has a total population of around 5.5 million. Paraguay is one of the smallest insurance markets in Latin America with a total income in 2000 of USD 78mn of which 7% came from life business.
Insurance is undeveloped and represented 1.10% of the GDP in 2000 with a per capita premium of only USD 15 (of which only USD 1 represented life insurance). The Paraguayan market comprised 41 companies at 30 September 2000, of which only two were composites with the rest licensed for non-life business only. It is considered that there are too many companies in operation for the size of the market.
Insurance companies currently write no health insurance business, although there is a sizeable volume written by pre-paid medicine companies (pre-pages). These do not at present form part of the insurance industry but the superintendence of insurance is attempting to bring them under its authority for the purposes of financial control. A decision of the Supreme Court is awaited.
State Healthcare
The most recent legislation regarding healthcare in Paraguay was Law No. 1032 of 1996, which created a national health system. The National Health Council is responsible for the coordination of activities in the health sector and comprises key institutions in the sector headed by the Ministry of Public Health and Social Welfare (MPHSW).
In the public sector healthcare is provided by the ministry together with services for the police and the military, plus municipal health services and the teaching hospital of the National University of Asuncion. The Instituto de Prevision Social (IPS) provides cover for occupational illnesses, accidents and disability for contributors in employment. Reliable statistics are hard to come by but the Pan American Health Organisation in 1999 stated that the ministry and other public services covered some 72% of the population, IPS 13%, with the remaining 15% in the private sector.
PAHO states that public health expenditure is USD 85 per head, or 7.4% of GDP. The estimated number of hospital beds is 6,655 or 1.3 per 1,000 of the population. The ministry, which operates in 18 areas plus Asuncion, states that it has 1,471 doctors, 234 dentists, 94 biochemists and pharmacists, 398 nurses and midwives, 916 technicians and 2,752 auxiliaries working in 17 regional hospitals, 18 district hospitals, 120 health centres, 634 health stations, 12 specialist hospitals and 8 specialist centres.
The public health service, whether that of the ministry or IPS, is severely deficient. Patient often suffer long journeys or long waits, or both, for treatment. PAHO states, "The health sector has no plan for coordinating the development of the operating capacity of its various institutions".
Managed Healthcare
According to PAHO the MPHSW does carry out health education in areas such as Aids, cholera, family health, nutrition and prevention of drug and tobacco use, but the geographical scope and effectiveness of such campaigns are not known.
Private Healthcare
As a result of the inadequacies of the state health service an increasing number of individuals with the financial means, and employee's in-group schemes, have access to private treatment from pre-paid medical companies (pre-pagas). At least two insurance companies are now involved as reinsurers of pre-pagas.
No statistics are available for the pre-paid medicine companies. The insurance superintendence does not publish separate figures for healthcare insurance; premiums are included under miscellaneous.
Individual Private Medical Insurance
Private medical insurance on the basis of reimbursement of costs is not available from insurance companies in Paraguay. There is currently no official classification for this class in the superintendent's statistics although there is various companies registered, of which Aseguradora Paraguaya (Asepasa) and Seguros Generales (Segesa) have the main involvement to date.
For the last 30 years there has been a thriving pre-paid medical "insurance" industry. The business is not written by insurers but by specialist "pre-pagas" which are not controlled by the insurance supervisory authority but by the health superintendence, the Superintendencia de Salud (Supsalud). This body carries out accounting audits and checks the pre-pagas' contracts, administration, finances and their ability generally to provide to the public what they offer. Supsalud requires the pre-pagas to have some form of capital, which may include property, of PYG 500m (USD136, 240).
There are 48 pre-paga companies currently registered, many of which have their own clinics and hospitals. The principal companies are Santa Clara, Golden Cross, Migone, Pro med, Reyva and Asismed.
Each pre-paga offers a variety of plans or policies which give different levels of cover including consultation, tests, in-patient care, operations involving appendix, prostate and the like, but excluding treatment of cases such as transplants and Aids. Santa Clara, for example, has six different plans giving different levels of cover to some 3,000 policyholders in 2000. It hopes to double its number of insured during 2001.
Santa Clara and Golden Cross have arrangements with Segesa and Asepasa respectively by which the insurers give a form of reinsurance cover in excess of USD 5,000 per claim in respect of the pre-pagas' large and complex plans. Segesa gives cover up to USD 1mn per year/event but with numerous sub limits.
PAHO states that the pre-paga system receives annual income of some USD 26mn. Segesa in the year to June 2000 received health premiums of PYG 600mn (USD 163,488), which were included in its miscellaneous account.
The pre-paid medicine market is in a state of uncertainty at present over the possibility of their coming under the financial control of the insurance superintendence. Until May 1999 the pre-pagas were controlled by the Finance Ministry and since that date by the Ministry of Health. However, since the introduction of the new insurance law, the insurance superintendence has been of view that it should control the financial aspects of pre-pagas, leaving the medical aspects under the vigilance of the Ministry of Health. Were this to happen, the pre-pagas would be required to deposit capital of USD 500,000, the same as insurance companies, to set up technical reserves and comply with solvency margins. The pre-pagas were vehemently opposed to this and, through their association CIMAP, started an action against the insurance superintendence. On 26 October 1999, the latter issued Resolution SS.RG.No. 008/99 reiterating the relevant articles of the insurance law which would appear to embrace writers of pre-paid medicine and medical insurance, declaring that the insurance superintendence should supervise the financial aspects of the pre-pagas and requiring that pre-pagas comply with the capital and other requirements of the insurance law.
A decision is now awaited from the Supreme Court. If the requirements for capital and reserves have to be met it is likely that the majority of the pre-pagas would have to close. It is believed that only about six would be able to meet the required capital base.
Group Private Medical Schemes
Employee benefits are rare in Paraguay but the main exception is group medical cover provided by the pre-paid medicine companies. In certain cases this benefit has been negotiated by the workers' trade unions. In some cases employees make a contribution to the premium; in others the employer is content to pay the premiums in full in the knowledge that employees will have immediate access to medical attention rather than waiting for hours or days for state treatment.
Some employers are said to give cash to the employees and leave them to purchase the policy. In addition there is small amount of major medical insurance written exclusively on a group basis by insurance companies in collaboration with the pre-paid medicine company. The cover is provided by and negotiated with the pre-pagas and the majority of the risk is passed to one of the insurance companies registered to write health insurance.
PAHO calculates that some 15% of the population is covered by private healthcare under either individual or group schemes, which would give an insured population of over 800,000.
The cost of pre-paga plans varies considerably according to cover given and whether family members are included. Basic cover is said to start at some PFY 75,000 (USD 20) per person per month. Rating for the risks covered by the insurance companies is fixed by the reinsurer, which accepts the majority of the risk.
The leading insurance companies involved in healthcare are Segesa and Asepasa. Other insurers said to registered are Alfa, Cenit, Escudo, Real, Rumbos and Rural.
The leading health insurance company has reinsurance placed on a 90% quota share basis into London.
Expatriate workers legally employed in Paraguay are required to pay social security contributions on the same basis as local employees and they benefit similarly. Separate arrangements may be made for employees in multinational companies.
DIRECTORY OF HOSPITALS & CLINICS
Centro Medico Bautista
Avenida Republica Argentina
Asuncion
Paraguay
Tel: + 595 21 600 171
Fax: + 595 21 602 212
Hospital Luz y Vida
J. E. Estigarribia
Ciudad del Este
Paraguay
Tel: + 595 61 572 343
Hospital de Clinicas
Dr. Montero
641 casi Lagerenza
Asuncion
Paraguay
Tel: + 595 21 420 982
Fax: + 595 21 480 529
Sanatorio Americano
Av Espana 935
Asuncion
Paraguay
Tel: + 595 21 213 492
Sanatorio Migone-Battilana
Eligio Ayala 1293
Asuncion
Paraguay
Tel: + 595 21 498 200
Sanatorio San Roque
Eligio Ayala 1383 y Pai Perez
Asuncion
Paraguay
Tel: + 595 21 228 600 |
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