The Dominican Association of Medical Equals and Health Risk Administrators (ADIMARS) filed an appeal against Resolution 624 of the National Social Security Council (CNSS), which establishes a redistribution of the funds received by the Health Risk Administrators (ARS) through a per capita model differentiated by age and sex.
According to ADIMARS, the supposed application of the resolution would affect the profit levels or administrative profitability of the ARS that make up the association and could even allegedly lead them to bankruptcy.
However, the CNSS has stated that the measure seeks a redistribution of resources based on the demand for health services of the affiliated population.
According to what is stated in the appeal, the legal action challenges Resolution 624 in all its parts and, allegedly, could stop the incorporation of more than 40 new medications to the Health Services Plan Catalog (PDSS).
There is also a warning about an alleged impact on the coverage of antiretrovirals for patients with HIV and tuberculosis, as well as surgical procedures such as gigantomastia for breast reduction in women and men, among other benefits intended for both doctors and members.
ADIMARS maintains that the ARS that make up the association have a portfolio of mostly young and male members, who, allegedly, have less use of health services.
However, the differentiated per capita model proposes a redistribution of funds to benefit ARS with a greater proportion of older adults, vulnerable people and women of reproductive age, sectors that most frequently demand medications, procedures and medical care.
The resolution establishes that ARS with young and mostly male members would receive a lower percentage of Social Security funds, based on the supposed lower demand for health services of this population group.
The hearing to hear the appeal filed by ADIMARS was set for next Wednesday, February 11, at 9:00 in the morning, at the Superior Administrative Court (TSA).
