Monday, May 31, 2010

>Cruel and Unusual Hassles in Chile

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>I have emphasized time and again on this blog that living in Chile provides some downright hateful experiences for Americans and Europeans. At the top of the list of evils are trámites, although waiting in line, poor customer service, people cutting in line, sadism (i.e., when those who enjoy frustrating you take the opportunity to do so), abuse of power, and compliance with stupid rules or procedures also cause considerable grief. Here are a couple of examples:

Tricky Prescriptions: Hard-to-Avoid Draconian Treatment (Spanish version below)

A person goes for his routine medical check up and finds out that his blood work shows that his thyroid medicine dosage is too low. So his doctor ups the daily dosage from 50mcg to 75mcg and gives him a new prescription. Prescriptions are not needed in Chile unless one is buying a controlled substance, or in cases when one wants his Isapre’s (private medical insurance) discount to be applied. This discount can be as much as 80% with some insurance plans so it makes sense to get a prescription from the doctor. Perhaps the person in question has been getting his 50mcg prescription filled at his pharmacy (Salco Brand, Cruz Verde, etc.) for many months, receiving his significant discount. But when he arrives with his new prescription for 75mcg he finds that the computer system shows that no discount applies. But why? He knows he has been getting the same brand of the drug in the lower dosage (with the discount) for many months, and that the medicine he needs is on the list of approved drugs. So he and the pharmacist spend 45 minutes on hold with the Isapre in order to find out why the computer system will not allow the discount to be applied. As it turns out, only dosages of 25mcg (US$6 before discount), 50mcg (US$8 before discount), 100mcg, 113mcg (US$10 before discount), 125mcg, and 150 mcg (US$11 before discount) of this medicine are covered under the discount. The 75mcg dosage must be purchased at full price (US$9 before discount). Probably the local data entry person at the insurance company was careless, or maybe even an imbecile, and just accidently did not include the 75mcg dosage. Why would the insurance cover all dosages but one? It is an obvious mistake. But that fact does not matter. The pharmacy will not give him the discount unless the specific drug is on the list. The frustrated consumer then asks if he can buy both 50mcg and 25mcg dosages. (After all, paying 20% of the price of two medicines is surely better than paying 100% of the price of one of them.) “No sir!” is the instance reply: not with a discount anyway. The prescription has to match exactly what is sold. At this point, the person begins to see the sadistic glee of the people in the pharmacy and has detected the same thing on the phone with the insurance provider. He asks: “What do I have to do?” Go back and pay for another doctor’s visit to get a new prescription that says one 50mcg pill and one 25mcg pill per day? “Yes sir!” You got it. But how is that for inefficiency? The person will try to explain all day long to the insurance company representative on the phone why this cruel hassle is so inefficient and stupid. But the representative has no control over company policy, even if he is able to see the ridiculousness of the circumstances. Unlike in the USA, he will not dare to correct the problem himself, nor will he report the inefficiency to his superiors. So the frustrated person will have to go back to his doctor and get a new prescription and, if he has good Isapre coverage, the insurance company will pay 70% to 95% of the consultation resulting in greater inefficiency for the insurance company. Based on the prices listed above, the person’s efficient solution is to get the doctor to write a prescription for 150mcg and take one half of a pill each day. The other choices are to get a box of 25mcg and a box of 50mcg, or boxes of 100mcg and 50mcg (breaking the pills in half for daily use). No other way out. And it makes for a really bad day in Chile when it happens to you. But with any of these strategies the bigger loser is the Isapre which is paying for 80% of each box of medicine. For example, instead of paying US$7.20 for the 75mcg pills, they will end up paying US$10.40 for the 25mcg and the 50mcg pills. That’s a 44% difference which looking at only a few cases would be a minimal inefficiency but considering all of the inefficient transactions nationwide becomes a significant problem.

Bowling Lanes Grief
Americans like to go bowling now and them. It is a clean, fun activity for families and groups of young people. There is not a whole lot of bowling in Chile, but there are at least a couple of sets of lanes in northeastern Santiago malls and another set in the mall in Viña del Mar. The cost is about US$23 per hour, which includes shoe rentals and up to four people bowling on a lane. However, the unwary American arrives and finds out too late, to his dismay, that he had to take a number in order to get service. There is no LED counter to indicate what number is being served, or a clear sign stating that a number is needed. Plus, the ticket dispenser is not in plain sight. So he waits for the persons ahead of him patiently, as Americans are prone to do, and the people behind the counter see that he is is waiting without a number (yet they do not bother to tell him to get one). Then enters a Chilean who knows about the need for a ticket and takes his number. Finally, the last person ahead of the American moves off to the side and the American hopes to have his turn, only to have his hopes dashed by the sly Chilean who rushes in ahead of him and presents his number. The worker does not even bother to look at the dismayed American. They know that it was cruel not to tell him about the need to take a number, and that is what makes the experience so enjoyable for them. He made the foreigner waste 20 minutes in line and that fact makes the worker feel a little bit powerful (which he enjoys immensely). Their sadistic side likes to watch Americans or anyone suffer on account of imperfect information. At this point, the frustrated American takes a number and goes to the back of the line, unless he is so frustrated that he just leaves. The latter event would probably generate the maximum amount of glee in the heart of the worker, who obviously cares nothing about either the firm’s profitability or making a customer happy. So much for customer service. In case the American had already had a bad day, it just got worse!

Afterword
Having said all of that, I should point out that there are many times in Chile where someone who does not work in the store will help a foreigner. This fact is especially true with respect to people from the upper classes which one meets in Chile. Plus, I have found that the police and many public employees are often very helpful to gringo residents. So daily events and shopping experiences are not always bad. It also makes a difference if one expects things not to go well or easy. Then when they do not go well there is not such a shock. And when they do go well the foreigner will be all the happier.

Ineficiencias de Isapres Cuestan Caro a Todos

Una persona va por su consulta médica rutinaria y descubre que el análisis de su muestra de sangre indica que la dosis de medicamento para la tiroides es demasiado baja. Así que su médico cambia la dosis diaria de 50 mcg a 75 mcg y le da una nueva receta. Por supuesto, las recetas no son necesarias en Chile a menos que uno esté comprando una sustancia controlada, o en caso que uno quiera el descuento que corresponde a su plan farmacéutico de la Isapre. Este descuento puede ser hasta un 80% con algunos planes de seguro así que vale la pena obtener una receta del médico. Quizá la persona en cuestión había estado entregando su receta de 50 mcg en su farmacia favorita (por. ej., Salco Brand, Cruz Verde, etc.) durante muchos meses, recibiendo ese descuento significativo. 
Pero cuando él llega con su nueva receta para la dosis de 75 mcg se encuentra con que el descuento no está registrado en el sistema informático. ¿Por qué? Él sabe que ha estado recibiendo la misma marca del medicamento aunque en una dosis más baja (con el descuento) por muchos meses, y que la pastilla que necesita está en la lista de medicamentos aprobados. Así que él y el farmacéutico pasan 45 minutos en espera con la Isapre con el fin de averiguar por qué el sistema no permite que el descuento se aplique. Como resultado, el representante de la Isapre en línea telefónica indica que, efectivamente, sólo las dosis de 25 mcg ($3.200 antes del descuento), 50 mcg ($4.600 antes del descuento), 100 mcg, 113 mcg ($5.000 antes del descuento), 125 mcg, y 150 mcg ($5.500 antes del descuento) de este medicamento están cubiertas bajo el plan de descuento. La dosis 75 mcg se debe comprar al precio sin descuento ($4.800 antes del descuento). Probablemente la persona encargada de ingresar los datos en la Isapre fue descuidada, o quizá incluso un tonto, y sólo accidentalmente no incluyó la dosis de 75 mcg. 
¿Por qué la Isapre cubre todas las dosis del medicamento excepto la de 75 mcg? Se trata de un error evidente. Pero este hecho no importa. La farmacia no le dará el descuento a menos que el medicamento específico esté en la lista. El consumidor frustrado luego preguntará si puede comprar las dosis menos como alternativa: la de 50 mcg y la de 25 mcg. (Después de todo, pagando el 20% del precio de dos medicamentos es sin duda mejor que pagar el 100% del precio de uno de ellos.) “¡No, señor!” es la respuesta inmediata. La prescripción tiene que coincidir exactamente con lo que se vende. En este punto, la persona comienza a ver la alegría sádica de la gente en la farmacia y ha detectado lo mismo en el teléfono con el proveedor de seguros. 
Él pregunta con exasperación: “¿Qué tengo que hacer? ¿Volver atrás y pagar por visitar a otro médico para obtener una nueva receta que dice una píldora de 50 mcg más una de 25 mcg al día?” “¡Sí, señor!” Usted lo consiguió. Pero, ¿Cuán grande es la ineficiencia? La persona trata de explicar todo el día al representante de la Isapre por qué esta molestia cruel es tan ineficiente y torpe. Pero el representante no tiene control sobre la política de la empresa, incluso si él es capaz de ver lo ridículo de la circunstancia. A diferencia de los Estados Unidos, no se atreverá a corregir el problema por sí mismo, ni entregar un informe de la ineficiencia de sus superiores. 
Así que la persona frustrada tendrá que volver a su médico y obtener una nueva receta y, si tiene buena cobertura de Isapre, la compañía de seguros pagará 70% a 95% de la consulta (dependiendo en el plan del afiliado) lo que resulta en una mayor ineficiencia de la compañía de seguros. Sobre la base de los precios antes mencionados, la solución eficiente es que la persona consiga que el médico le escriba una prescripción para 150 mcg y tome la mitad de la pastilla cada día. Las otras opciones son conseguir una caja de 25 mcg y una caja de 50 mcg, o cajas de 100 mcg y 50 mcg (partiendo las pastillas por la mitad para el uso diario). No hay otra salida. El consumidor está frito en Chile. Y cuando esto ocurre, se transforma en un mal día para Ud. en Chile.
No obstante con cualquiera de estas estrategias del afiliado, el perdedor más grande es la Isapre que está pagando el 80% de cada caja de medicina. Por ejemplo, en lugar de pagar 7,20 dólares por las píldoras de 75 mcg, va a terminar pagando 10,40 dólares por las píldoras de 25 mcg más las de 50 mcg. O sea un 44% más que si comprara la de 75 mcg. ¡Imagínese cual es la pérdida cuando se suma todas tales transacciones ineficientes en Chile! Tales ineficiencias y estupideces no corresponden a un país desarrollado ni tampoco son buenas para sus empresas ni sus consumidores. Es una tontería que se debe corregir pronto para flexibilizar las políticas internas de las Isapre.

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2010-05-31