La judicialización. No es el mayor problema de las ISAPRES: es un síntoma de un sector en crisis

Abstract

The problem with the price raise of the medical plans of the ISAPRES is a destabilizing factor in the industry, because of the amount that these are increasing and the way they are set. ISAPRES have increased their prices in real terms way over the IPC even though all the prices are set in UF. On the other side these companies apply a model of price setting of primes adjusted by risk (the greater the risk the higher the price) in a framework of complete freedom to define de readjustment of the base plan of each ISAPRE. The private system has been judicialized and in 2012 there were over 47.000 sues, every one of them won by the affiliates by the application of the boards adjusted by age and gender leaving this model of rating obsolete. By the end of 2012 new decisions made by the Supreme Court, about sues against the way the price is readjusted in the plans of each ISAPRE and that these should justify in an adequate form. The court once again supports the affiliates considering that the amount of prices sued were insufficiently justified, even pointing out that the ISAPRES cannot use the raise in the frequency of the service use as a justification because its consubstantial to the risk that they administer leaving another key element of this price model obsolete in the ISAPRES. In this article the authors make a detailed analysis of the context in which the problem is developed, about the judicial decisions taken and their consequences on the system concluding that it will be necessary to make a profound reform in the ISAPRES system.