Response to consumer reports questions from st petersburg general hospital

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Institutional health insurance is better than private health insurance

In Mexico, even with the criticisms that are made related to the quality and problems of access to care in institutions such as the IMSS or the Institute of Security and Social Services of State Workers (ISSSTE) due to the administrative bureaucracy that must be overcome to be served, is undoubtedly a more profitable investment.

The resources deducted from the worker for being attached to one of these institutions -for his health care- provide him with the right to complete care, and in proportion he receives much more in medical and health services than if he invested that money in private insurance.

In these institutions, the insured does not have difficulties to be insured, neither due to age, nor due to persistent illnesses, and when he becomes ill, his insured situation persists, even if the illness for which he is treated in the institution is high cost and of prolonged time. .

Private medical insurance has numerous and diverse limitations: it is easy to enter if you are young and healthy, very difficult and very expensive if you are elderly. And if the insurer, when doing the medical examination – an essential requirement that one of their doctors performs on the candidate for insurance – finds any data that makes them suspect a persistent illness, it will be rare for them to accept to insure him, thus excluding him not only from the attention to his supposed illness, but also to those that in the long term could be a consequence of it.

Insurers often find explanations or reasons to avoid their obligations

Among which are: congenital conditions, the obligation to allow a waiting period to elapse to be covered, pre-existing diseases, even causes such as lack of breakdown or account statement of bills, expenses that do not exceed the contracted deductible or benefits that exceed what is contracted by the policy (physical therapy, prosthetics, intra-hospital consultations and even maternity).

Sometimes, after a patient undergoes tests due to an alleged illness or accident, if the results are negative, the insurer will refuse to pay the cost of the tests, arguing that they were performed as a health “checkup”.

Insurers often find explanations or reasons to avoid their obligationsOne of the most serious limitations suffered by an insured is that he must renew his insurance policy annually;

If a few months before the renewal the person suffers from a serious condition, the insurer accepts the next renewal, but excluding that condition or illnesses that may derive from it, or in any case the renewal implies a higher premium.

A variety of private insurance is one in which the patient agrees to be treated by a group of doctors who are employees of the insurer; there the limitations are the instructions given to these employed physicians that they must restrict the use of expensive medications, carry out the minimum of laboratory and cabinet tests, and avoid hospitalization.

  • In the latter case, the insurance is not only limited, but also a conflict of interest is caused, since the insurer does not care for the patient’s well-being and the preservation of her health, but rather for its commercial interests.
  • It is the figure known as a gate keeper doctor, that is, the role of the goalkeeper in a soccer team whose function is to stop the goals.