The Colombian Association of Comprehensive Medicine Companies (ACEMI) has presented a crucial analysis to determine the necessary adjustment to the Capitation Payment Unit (UPC), which must be implemented from January 1, 2025.
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This study is based on information provided by eight affiliated Health Promotion Entities (EPS), which represent 65.3% of the Contributory regime and 27.7% of the Subsidized regimecontributing a total of 532.5 million records valued at $35.8 billion to the Ministry of Health and Social Protection (MSPS) for the 2025 sufficiency exercise.
However, the absence of data from the New EPS stands out, which groups together 22.7% of the members of the health system and whose reports are not available.
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The data quality and validation process, based on feedback from the Ministry of Health, revealed that 95.9% of the records were valid, along with 91% of the reported costs, which is equivalent to $31.7 billion validated for these eight EPS.
This result contrasts with the analysis carried out to calculate the 2024 UPC, which considered a more limited universe of 13.1 million affiliates and $16.8 billion. The evident improvement in the quality and breadth of information available for the 2025 estimate underscores significant progress in the reporting and validation processes.
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The calculation of the UPC for 2025, which corresponds to the MSPS, must include various fundamental elements to guarantee its sufficiency. Among them, there is the consideration of the population exposed to risk, pending compensations from previous periods, and an inflation update that reflects both the caused and expected inflations of 2024 and 2025.
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Acemi estimates that this so-called “inflationary trend” will be around 11.3%. In addition, the exercise must incorporate an analysis of the frequencies of use of the system using a statistical model that determines its long-term trend.
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Estimates from the union and the MSPS suggest that this annual variation would range between 6% and 7%. On the other hand, an adjustment must be made corresponding to the services that have already been provided but have not yet been reported by the EPS (known as IBNR), which represents approximately 3.6% of the annual costs of the system according to MSPS data.
If new services or technologies are included, These must be financed adequately, taking into account the increase in their use once they are incorporated into the financing of the UPC..
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According to what Acemi mentioned, Correct technical and actuarial modeling of health risk is essential to safeguard the right to health of Colombians. The precise quantification of the risk premium represented by the UPC is essential to guarantee both the financial protection of households and the adequate financing of the services and technologies included in the Basic Health Plan (PBS).
(See: Andi estimates that the UPC should grow 16.9% by 2025, thus stabilizing the operation)
However, An incorrect determination of the rate could exacerbate problems of financial insufficiency that already affect the sector. According to financial figures from September 2024, the system has an aggregate accident rate of 108%, which means that for every 100 pesos received for UPC, the expense amounts to 108 pesos.
This accumulated deficit has generated a insufficiency close to $6.3 billion in the last three years, without including administrative costs, according to calculations by Acemi and other experts on the subject. The decision on updating the UPC constitutes a responsibility of vital importance for the stabilization of the health system in Colombia.
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