Teoría de los juegos de las aseguradoras de salud

La semana pasada renuncié a la cobertura de Seguros Rimac en mi trabajo después de recibir por parte de ellos una pésima atención un par de veces. Conversando con un amigo médico me comentó que hice bien al salirme porque el servicio de Rimac en general era malo pero también me recomendaba tomar seguros Pacífico porque uno nunca sabe que le depara el futuro y le parecía que se preocupaban más por sus clientes. Lo pensé bien y después de meditarlo bastante quede con Solidaridad. La atención es buena, rápida y los precios módicos. Si tuviera que operarme puedo acudir a Essalud aunque claro fácil me ponen en lista de espera hasta el próximo año. Pero prefiero eso a saber que en Rímac voy a pagar por gusto para nunca atenderme o en caso de alguna emergencia quedar fuera de la cobertura.

Bueno después de esta catarsis quería analizar un poco el tema planteándolo desde la óptica de la teoría de los juegos. Los jugadores son los siguientes: Las aseguradoras que quieren que más gente se afilie a sus coberturas y el gran público que desea obtener un respaldo confiable en caso de algún suceso. Las aseguradoras buscan maximizar sus ganancias expandiendo su mercado y diversificando sus coberturas. El gran público busca minimizar sus pérdidas en caso que necesiten acudir a un centro de salud. Planteo los siguientes supuestos:

1. El gran público no está obligado a tomar los servicios de una aseguradora.
2. El gran público solo puede elegir los servicios de una “gran” aseguradora.
3. La aseguradora puede brindar un buen servicio o un mal servicio.
4. Si la aseguradora brinda un buen servicio sus costos aumentan.
5. Si la aseguradora brinda un mal servicio sus costos disminuyen.
6. En caso de no tomar los servicios de la gran aseguradora el gran público deberá asumir los costos totales de los servicios de salud que utilice.
7. Si la aseguradora brinda un mal servicio el gran público deberá asumir gran parte de los costos de los servicios de salud que utilice aun habiendo tomado la decisión de afiliarse.

Estos supuestos me llevaron a la siguiente tentativa matriz de pago:

seguros

La matriz nos indica que el punto de equilibrio en este juego no cooperativo se encuentra cuando el Gran Público se afilia a los servicios de la Gran Aseguradora, que es lo que suele ocurrir, mientras que por su parte la Gran Aseguradora tenderá a brindar un mal servicio al Gran Público, que también es lo que suele ocurrir. Siempre de acuerdo a la Teoría de los Juegos caemos en la cuenta que a menos que el entorno y por lo tanto las condiciones del juego cambien será siempre el Gran Público el más perjudicado. Para mejorar las condiciones del GP planteo las siguientes mejoras del entorno:

1. Ingreso de más aseguradoras de salud que compitan por el mercado ofreciendo mejores servicios o precios más atractivos.
2. Intervención del Estado para fiscalizar el comportamiento de las aseguradoras de salud a fin de garantizar un buen servicio para el GP.

En el caso peruano no se dan precisamente las mejores condiciones dado que tenemos un oligopolio muy fuerte manejado por Rimac y Pacífico y por otro lado tenemos un Estado muy débil a la hora de defender los derechos de los asegurados. Sin embargo esto puede cambiar si las pequeñas aseguradoras que están entrando al mercado se fortalecen y logran posicionarse en algún segmento determinado. Por nuestro propio bienestar espero que ocurra pronto.

Saludos, Renzo

Puntuación: 5 / Votos: 2

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