The discussion of the Colombian health system moved to technical tables convened by the Seventh Commission of the Chamber and the Government, in which the participation of the actors in the sector has become essential to discuss the future of the system and the definancing it is experiencing. himself.
Ana María Vesga, president of the Colombian Association of Comprehensive Medicine Companies (Acemi), a union that brings together the contributory EPS, spoke about the concerns about the new reform implemented, the transformation of these entities and also, the reasons why health spending is increasing.
(Read: Nike shares fall 7% after withdrawing its 2025 forecasts)
How do you see the process of the technical tables?
For the first time it is done with a plural participation of actors from the sector, convened by the Seventh Commission of the Chamber, also by the Ministry of Health and the Ministry of the Interior. We have recognized that this is a space that was needed and we had requested.
In the review of the articles we have said three things, first, the current reform is not very different from the one that was not approved in Congress during the last legislature. It maintains the essence in a more synthetic and short way. It implies a change in the material health model that certainly has implications for users and the way in which patients use health services. In addition, it has implications for resource management. This is not something positive or negative, but rather the substance of the proposal is changing the model radically.
We recognize the importance of the table, we intend for it to be a space for construction and search for consensus. We will provide elements for the Commission to build its presentation and the decision on the reform is in Congress.
What points do you have doubts about?
It is not a cosmetic reform, it is a substantial change to the system. We have insisted that it is very important that the roles and responsibilities in the system are very clear. For example, what happens with EPSs transformed into managers, since some of the functions they have today in insurance are maintained, but they abandon others or begin to share them with various agents. In this cooperation, responsibility is diluted.
Health risk management, that is, the agency work that we do for our users, has to remain in the hands of the manager and this is very important for patients because they want to know who represents them, or to know who is in charge of have an organized network. We insist that it must be preserved in the discussions on the articles.
(Read: MinTIC launched a new call for ‘Your Business Online’: steps to participate)
You met with the Ministry in April, what happened there?
That happened before the previous reform collapsed. On that occasion we looked at some articles for the transformation of the EPS into managers, some of these agreements are in this new bill and others are not. We have said in the installation of the tables what is recognized, for example, that we must participate in the formation of the network and that would be together with the territorial entity and the manager.
However, there are other things such as the hiring task that worries us because we see it as diffuse. Also the work of reference and counter-reference of users is not clear. There is no new agreement here and the table is barely moving.
Are you concerned about the financial management contained in the reform?
There is a lot of concern about this part of the project, since it does not propose a person responsible for the financial management of the system and part of what we do today is to ensure that the Capitation Payment Unit (UPC), that the resource that is delivered by each citizen It is managed efficiently and comprehensively.
When the EPS does not have enough resources, they expose their assets and end up in the financial situation they are in, but there is no financial person responsible for the system and that is something that will have to be discussed and improved.
(Read: Ranking: these are the most innovative companies in Colombia)
Did you manage to build an article in the meetings with the Government?
The Government and EPS met to see what the transformation could be and that was what was left of that meeting. If I return it, there would be nine articles about the intention of the EPS to become managers and why they do not want to continue managing the financial risk of the system.
What is sought is to preserve health risk management on the population and that has certain functions and there are some that are good and others about which we are going to continue insisting that they are still not clear. But that we are going to bring out or that we would have thought about bringing out a consensual reform, no.
There are many things that were discussed at that table that are not in the text and there are other things where the Government committed itself. For example, hold a table on current system financing issues. This never happened.
On that occasion we asked for progress to be made in an in-depth review exercise of the UPC, of the system’s financing, and that has not happened either. Today the sector is extremely underfunded and we pay loyalty to what we said and agreed with the Government. But we will continue to insist on the issues in which there are concerns.
Health spending is growing, how do you see the dynamics?
Evidently, the deterioration that the system is experiencing in the intervened and non-intervened companies, the portfolio with the hospitals or with the suppliers, means that Colombians are experiencing more difficulty, in attending appointments and particularly in the delivery of medications. Also, there is a lot of uncertainty about what will happen to the system.
We are seeing two things, the first is the increase in the purchase of voluntary health plans in any of their categories, we are talking about complementary plans, which are those that offer the same EPS, health policies or prepaid medicines. Due to this growth, we expect that by 2024 the voluntary health plan market will close at approximately $12 billion. This is a result of people who have a little more purchasing power deciding to buy a policy or go for a prepaid policy to insure themselves.
(Read: The Avivir Zue megaproject arrives in Soacha)
The other is the out-of-pocket expense, in regards to the purchase that is personally made at the pharmacy for the medication that they do not deliver. According to data from Raddar, it is said that households are spending more on health and that has both to do with private plans and the purchase of medications.
Does the reform take this into account?
This is a guarantee reform that seems to want to eliminate all barriers within the health system. What I do believe is that what produces this increase in out-of-pocket spending is the uncertainty generated by this discussion and the very fact that the population is feeling that they cannot access it easily, and those who can pay.
What repercussions are there on non-payment of maximum budgets?
This is very serious and has implications from the legal point of view of compliance that draw attention, because the Constitutional Court has said months ago that the Government has poorly calculated and paid the maximum budgets.
The adjustments from previous years are being paid with a very costly delay for the system and the current payment is not happening as it is. The adjustments for the year 2022 are $820,000 million, where this is the time in which they have not been paid. How much is it worth to leverage financially for two years? Almost a billion pesos. Which has an associated financial cost that has deteriorated and further deteriorates the financial status of the EPS.
Currently they did not pay us July, August, September and now in October, there is no hope. The Government underestimated these resources at the beginning of the year and one would think that these budgets are not guaranteeing their closure in the year.
And the problem is that this has a direct implication on users because these budgets are essentially to pay for health technologies. There is a financing problem at UPC and if cash problems are added to this, it means that the EPS cannot comply with their agreements with the pharmaceutical industry, with managers or suppliers, etc. Even the managers are not delivering medicines, which has a direct implication on high-cost medicines, essentially.
