Santo Domingo.- The thrust of Dominican Republic’s health risk managers (HRM)  in a relatively short time came to the fore on Thursday, when the country’s major association (ADARS) presented its statistics on the services provided by its members up to February.

ADARS said its health risk managers paid more than RD$12.6 billion to the Health Services Providers in 2009, for an increase of 33%, whereas doctors, labs, pharmacies and clinics received a total of nearly RD$12.6 billion, the latter getting nearly RD$7.8  billion, or RD$2.3 billion more than in 2008.

ADARS’ report also reveals that of the Family Insurance System’s (SFS) 2.2 million total affiliates, 1.49 million belong to private ARS and 1.35 million (91%) of  these belong to its Association,.

It stressed that private risk managers assigned to the Social Security Contributing Regime provided services to 67% of the Family Health Insurance’s affiliates, compared with 22.4% in public risk managers and 9.9% in autonomous entities.

The report notes that the number of affiliates in private, public and autonomous HRMs rose 20.6% from February 2009 to February 2010, of which 72.2% correspond to private managers.

The report also stresses that of total of 284,495 affiliates transferred to the HRMs according to the Free Choice implemented from August 18, 2008, to February 28, 2010, 77.1% decided to enroll in a private HRM and 21.8% in a public one.

The data analyzed by ADARS Governing Council president Eduardo Cruz and its Executive president Jose Manuel Vargas show that its affiliate HRMs provided more than 20 million services to their affiliates in 2009, for an average of 12.2 services per affiliates compared with 10.9 services on average provided in 2008.

“Affiliates are increasing using more services, which indicates that the system is consolidating,” Vargas told a gathering of reporters who specialize on economic topics.

“In 2009 the 9 HRMs which conform this Association provided more than 4,765,896 services in 2008, which represents an increase of 30% from a one year to another,” he said.

“The most numerous services provided in 2009 were lab tests with 36%, followed by hospitalization with 17%, ambulatory consultations with 16% and ambulatory medicines with 12%,” Vargas said.

The Association’s executives also disclosed the results of a 2009 Gallup survey which measured the levels of satisfaction of the HRM’s affiliates, which found that more than 86% of ADARS affiliates are satisfied with their current private HRM.

Fraud risks

When asked about the ADARS’ controls against fraudulent claims, Vargas didn’t provide specifics but noted that the HRMs work together to detect them, and cited cases of identity swaps among the most common.

The HRMs ARS Humano, ARS Palic Salud, ARS Universal, ARS SDS, ARS Colonial, ARS Sigmag, ARS Yunén, ARS Monumental and ARS Banreservas (State-owned) conform ADARS.