Remove the right of admission and triple contributions to Fonasa: legal changes for private health insurance

Shortly before leaving her position as general director of Health, to become the first female professor in Gynecology, Fernanda Nozar had told The Observer: in the Uruguayan health system There is “competition that in certain circumstances is unfair.”

Within this disloyalty, he placed special emphasis on private health insurance. Not only because of the concentration of resources but because of the “filters” with which, unlike the rest of the Integrated System, they choose who they accept as users and who they do not. Or by how much they return to the State from the investment that the public coffers make in these institutions.

The Observer He had anticipated that this would be materialized in a bill after the discussion of VIP services in mutual societies. And now that text arrived with a single article that requires two things:

• “Comprehensive insurance 18% of the income received from Fonasa itself will be poured into the National Health Fund for administrative, management and promotion expenses, under the conditions determined by the regulations.” This represents a tripling in percentage points of what applies under current regulations.
• “Insurance must apply the same admission criteria of your users than those used by providers of the National Integrated Health System.” Canceling the registration of cancer patients and setting age limits is no longer valid.

The project takes the signature of the bench of Deputies of the Frente Amplioalthough the discussion does not have an express political-partisan division.

The president of the Health commission, the former undersecretary of the MSP José Luis Satdjian (National Party), explained to The Observer which is not contrary to the spirit of the initiative, but which, in a quick reading, sees weaknesses.

“There is a basic problem when the National Integrated Health System is created in which certain things are allowed and that is later more difficult to correct as we go, and, along those lines private insurance is freely contracted Therefore, in practice, it is difficult not to avoid the right of admission.”

What does it refer to? If the bill is approved as drafted, a private insurance company can say that it accepts a patient with a history of oncology that it did not previously accept, or an older adult, but sets the price of the “fee” you want for that pre-existing condition.

Dr. Gustavo Mieres, who has dedicated himself to studying the health system, summarizes it like this: “The initial sin was having enabled private insurance companies to attract Fonasa users using different rules than the rest of the providers that make up the System.”

This can be seen in how the insurance population is more youthful, largely due to this right of admission:

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The Integrated System is about to turn 20 years old. An entire generation has grown up thinking that health in Uruguay was always like this. But like any structural change, where sometimes there may be some concession for the project to come to light or some design error that was not thought of at the time, the political authorities of the ruling party They understand that it is time to do the review.

The National Board of Health is not avoiding the issue and has been discussing the matter for some time. Sources from the organization explained that the bill in question sets up the discussion, but later in the parliamentary debate it has to be improved. Even They do not rule out putting limits on free contractingsome type of restriction to really comply with the spirit intended by the regulatory modification.

Private health insurance is the smallest part of those affiliated with providers: with 127,131 (89,724 of which have Fonasa) represent 3%. But, unlike other providers, they have not fallen over time and have even increased at times. That is with the most updated data from March 2026.

Those who have to resolve this are the representatives of the population, the legislators. But just because a legislator represents does not mean that the integration of Parliament is a miniature copy of the characteristics of the Uruguayan population. Not only because there are (many) more men than women or because the educational level achieved is higher than the average, but because according to the last count that had been done The Observer, 12% are covered by private insurance.