Draft bill on medical licenses.

The series of reports from the Comptroller General of the Republic regarding audits of workers who received disability benefits associated with medical licenses – a process that began in May 2025 – had a significant impact on behavior. The number of monthly medical licenses decreased almost immediately after the first audit, and has remained lower since then. This resulted in a reduction of one million licenses in 2025 compared to 2024, which, according to estimates from Suseso, could have saved approximately $500 billion in this area. While it is necessary to quantify this effect with real data, the sharp decline in the number of licenses indicates that there is a group of individuals and healthcare professionals who are willing to misuse this healthcare instrument. Furthermore, it shows that the impact of auditing has its limits, as the decrease is consistent or equal each month compared to the previous year. This raises the question of what would happen if active auditing were discontinued, and what other measures are needed to prevent this reprehensible behavior. International evidence provides some insights into alternatives to auditing: establishing standards to guide the actions of doctors and those who authorize and audit sick leave; reducing the duration and amount of the benefit associated with the license (in other countries, these are temporary benefits, for a fixed amount or a proportion of the salary less than 100%); and involving employers in the auditing process, either through incentives or the payment of some days. The answer to the first question is more complex, as several of the methods used for auditing (data cross-referencing) and subsequently for sanctioning (disciplinary proceedings) already exist. However, they are not used due to a lack of incentives and resources, especially in the public sector, where disciplinary proceedings can be lengthy and costly. These considerations are largely addressed in the draft law on medical licenses – prepared by the previous administration – which is currently under consideration, and its prompt approval is therefore important. Among other aspects, it establishes that disability benefits will have a two-day waiting period, regardless of the duration of the leave, and that this will apply to all workers. This equalizes the working conditions in the private and public sectors, considering that in the latter, there is no waiting period or salary cap. Furthermore, it seeks to reduce short-term leaves, especially in the public sector, as data shows that most of these occur on Mondays and Fridays. In the private sector, the goal is to eliminate the incentive to artificially extend the duration of medical licenses, so that the discount on the waiting period days is not applied, which requires leaves of 11 or more days. In addition to this, the initiative grants the Isapres (private health insurance companies) and the Compin (social security fund) the authority to audit the proper use of this healthcare instrument, strengthening the auditing process. Despite the fact that the proposed changes are limited and enjoy broad technical consensus, the legislative process is progressing with inexplicable slowness, so it is hoped that both the executive branch and the parliament will expedite the process, and that healthcare unions will not be an obstacle.