Regions raise alarm over glitches in medical co-payment system

Many are paying too much or too little for drugs due to classification flaws

Campaigners say that the co-payment measure is "unfair," and "harms the most vulnerable."
Campaigners say that the co-payment measure is "unfair," and "harms the most vulnerable."Pedro Agrelo (EL PAÍS)

The co-payment system for prescription medication continues to suffer from numerous glitches. Six months after new regulations went into effect, which raise the percentage paid by users of the public health system based on income levels, there are still hundreds of patients who have been classified incorrectly and are paying either too much or too little.

Regional governments have alerted the central authorities and asked them to fix the errors. Some officials also fear that the Health Ministry's plans to create new divisions within the current income bracket of 18,000 to 100,000 euros (these patients now pay 50 percent of the drug price) will only increase the instability of an already complex computer system and revive the same problems that occurred during the first weeks of its implementation.

The Health Ministry, meanwhile, claims that the problems are very localized and quickly resolved. In April of last year, the conservative government of Mariano Rajoy introduced a historical change in modern Spanish history: for the first time, pensioners would also have to partly pay for their medicines. As of last July, they foot 10 percent of a medicine's cost, with a monthly ceiling of eight, 16 or 60 euros depending on their income levels.

Juan Francisco González has been retired for close to four months, but when the doctor prescribed several drugs two weeks ago to treat his urine infection, he discovered that the system had him down as a worker who makes between 18,000 and 100,000 euros a year. This meant that he had to pay half the cost of the medication.

"I found that strange, but I still paid," he says. Later, he filed a complaint with the Madrid Health Service, and is still waiting to hear back from them.

Ana Mato's ministry admits that there might be some "instances of discrepancy" in the income classification, which is obtained by cross-checking data from Social Security, the Treasury and regional health services. Ministry sources said that a circuit has been created so that regional authorities can inform central headquarters about mistakes and have them corrected.

But some officials are taking their concerns further. The small northern region of Asturias has appealed several points of the health reform to the Constitutional Court, including the co-payment hike. Five other regional governments have done the same, including Andalusia, which has also complained to the central government delegate about the chaos.

Murcia reports fewer glitches than in the first few weeks of implementation, and has developed its own troubleshooting system. In Navarre, the authorities have come up with their own way of dealing with mistakes while they wait for the central government to get to them. "When we detect an error, we classify that user in the lowest co-payment bracket so he or she is not harmed by the mistake," says a spokeswoman for the Navarre health department.

Lorenzo M. does not find the system detrimental to himself, but he does find it irritating. Several months ago this businessman temporarily suspended his employees' contracts because of the crisis. Since then, the system considers them long-term unemployed, basically because it lacks a category for short-term unemployment. This means that he and his workers pay nothing for their medication.

"I am incensed," he says. "My parents, who are retired, have to pay, but I don't. I don't know how they came up with this rule, but it's full of holes," he says, adding that the crisis is causing dramatic changes in family incomes in very short spaces of time, changes the system doesn't pick up.

Something similar is happening with workers who apply for early retirement: this concept is not reflected by the system, so many people end up classified as unemployed in the databases.

"We're finding some very shocking cases," says Alejandro Toledo, president of the General Alliance of Patients, who is demanding that the government solve the problems associated with this "unfair measure, which harms the most vulnerable people."

Marciano Sánchez Bayle of the Federation of Public Health Defense Associations claims that around 17 percent of pensioners have stopped buying medication they need because they can no longer afford it.

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