In 2018, the Ecuadorian Institute of Social Security (IESS) spent USD 732.2 million in the payment of its payroll, which reached 38 154 employees last December. If the benefits of the law are added to this value, the expenditure amounted to USD 980 million.
The number of workers is twice as many as there were six years ago, when they were 19 520, according to data of the entity to which this newspaper agreed. One of the factors that explains this exponential payroll growth is the decision to extend, in 2010, medical coverage to the children of members and retirees from 6 to 18 years of age, without the corresponding financing, which increased the demand of attentions.
Of a coverage of 2.8 million people in 2008, it reached 9.6 million last year; that is, the entity meets the health needs of just over half of the population of Ecuador. The attention provided by the IESS also includes retired people, housewives and people with disabilities or catastrophic illnesses, for whose medical expenses the State should contribute, but it does not.
In addition, it assists affiliates and beneficiaries of the Rural Social Security.
To cover this growth in demand, the IESS built new hospital units and increased its staff. The most important increase was made in the administration of Richard Espinosa, who chaired the entity between March 2015 and December 2017. During that period, the payroll increased by 11,098 workers.
An attempt was made to contact the ex-official via telephone, to find out his position in this regard, but it was not possible to locate him. Geovanna León, director of the IESS at that time, indicated that because it was a payroll issue, those in charge of Human Talent should respond.
The former manager of that area, Rodrigo Mendoza, did not answer the calls. Ramiro González is followed by Espinosa, with an increase in the payroll of 8,773 people. The former official was almost five years in office and today is a fugitive from justice. In third place is Víctor Hugo Villacrés (April 2014 – March 2015), with whom the payroll increased by 5,346 employees.
Villacrés justified the increase due to the expansion of Health Insurance coverage. One of the indicators that the entity has used to measure its care is the number of beds and doctors per 10,000 beneficiaries. After an analysis of how this indicator decreased since 2011 and the development of a strategic plan – the former official said – it was defined that it was necessary to hire 6,600 more doctors.
The former official acknowledged that the number of posts increased, but basically they were doctors. Of the current IESS payroll, about 27 500 people belong to the medical staff. Of these, the group with the highest growth is “other health support professionals,” which includes auxiliaries, stretchers, nurses, therapists and other positions.
Despite the increase in the payroll in the health areas, the Ecuadorian Medical Federation ensures that high demand has not yet been met. “Growth is the product of technically impossible government offers,” said Ernesto Carrasco, president of the union.
Another factor that presses the health demand of the entity, according to the manager, is the attention to beneficiaries of the Seguro Campesino, which totals 1.2 million people. But not only has the health area had more staff. The IESS closed 2018 with 10 660 administrative staff; that is, 4 089 more than six years ago.
A doctor at Teodoro Maldonado Carbo Hospital in Guayaquil, who preferred to reserve his name, has observed an “exaggerated” increase in the administrative area of that health house during the last 10 years, while there is a shortage of doctors and beds. In the area of hematology, said the doctor, there are seven doctors, but five more are required.
He said there are about 40 people waiting for a shift in hospitalization. For this server, the first measure that the IESS requires is its “depoliticization”. He recalled that the income of the staff should be by competitions. “There are doctors who have been waiting for a definitive appointment for years.” As of last December, 9 108 workers had a provisional position.
In April 2017, the IESS created 182 positions for the project “red vests”, servers that provide information to patients in medical units of the Insurance. In Resolution 550, with which these items were created, the hiring was justified “to improve the efficiency of the different services and services that optimize the quality, transparency and warmth of the service”.
Last Friday, at the Carlos Andrade Marín Hospital (HCAM), in Quito, there were two of these officials in the area of appointment appointments. One helped maintain order in line or answered patients’ concerns and another facilitated the entry of people with disabilities.
While the entityand attempts to improve the service, the delay in the delivery of appointments follows. Last week, Aída Pinta, a 55-year-old affiliate, obtained an appointment for otolaryngology for next May 30 at the HCAM.
This newspaper asked the IESS if it had planned to optimize the staff this year. The entity said it is processing the response. The president of the IESS, Paul Granda, said last January that he will seek to have “an optimal payroll”. (I)