The bid for the future of the health system revived after President Gustavo Petro will incite the fact that the bill that seeks to modify the country’s system to continue its debate in the Senate of the Republic, but also, Because not only a negative or archive paper was settled, but an alternative of Senator Norma Hurtado, which is based on the technical health tables.
(Read: Fiscal endorsement of health reform raises more public spending and less resources)
Specifically, this alternative project differs in some aspects of the current one approved in the House of Representatives, that is, that of the Government. Very specific, The new presentation proposes changes in the audit and medical control model, in the tariff regime and payment for services, on the fiscal impact and financial viability and in the role of ADRES within the health system.
Now, one of the high points has to do with the resources of the system and the fiscal impact of the articles. In detail, the text approved in Chamber, presents a fiscal analysis that projects long -term sustainability, where a surplus in 2034 of $ 47 billion is estimated. Likewise, sources such as healthy taxes, social VAT and an additional point of GDP are included.
However, in the alternative the methodology of the government’s fiscal analysis is questioned, warning about inconsistencies between the tax impact concepts issued on different dates. Promptly, The document indicates that the increase in spending is not supported by real structural income and a possible double accounting of sources and use of temporary resources as if they were permanent.
(See more: Fomag expands its pharmaceutical network with more than 1,100 dispensing points)
The government’s fiscal analysis projects a $ 47 billion surplus in 2034, with healthy tax revenues, social VAT and an additional point of GDP.
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Now, taking into account that the bid in Congress is already feeling, because the pro and against those are present, experts in the health sector argue that the government articulated continues to be unfeasible and continues to lead to the health system to a crisis, without solving the structural problems that the sector currently has.
In that sense, one of the most constant questions arises in the sector and this has to do with what to discuss a reform if the government is approving it through decrees? According to Augusto Galán, director of Thus we are in health and former minister of the portfolio, It is very likely that the decree also has a bleak end and has a high probability that it falls.
“They will have advanced in the regulations, but it can generate a setback that will end up falling, because the decree for many is illegal and even unconstitutional, and it is possible that the State Council ends it by annulling it”He said.
To this, the manager added that one of the reasons why the regulations would fall have to do with what a law is needed to modify the system, which until now the government does not have. “That is why in an eventual law of competencies, they will also include a modification to the health system as far as modifications are allowed, as in territorial entities. It would not be a complete reform by law, but it would be another way was another way that the government would try to force what you want,” he said.
(See more: Possible liquidation of the new EPS would be a ‘smoke curtain’)
Experts warn inconsistencies in fiscal calculation and denounce double accounting of sources and use of temporary resources and permanent.
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For his part, the political analyst, Carlos Arias, said that what the government seeks with the discussion of the project is a media exercise, that allows them to build or reaffirm the narrative of the change and that the legislature has not allowed them to govern.
“What they are looking for is that media exercise that returns that narrative that they will not let them govern and that they tried until the last moment, because the reform will not happen and that is why it has been implementing it by decree. Clearly they are making much more noise so that it is evidenced that if it falls it is not because of them but because of the legislative”He insisted.
Now, from the point of view of the EPS the debate also needs more livelihood. According to Ramón Abel Castaño, consultant in health systems, the elimination of these entities, which is one of the government’s objectives, They cannot do it through a decree, which would explain the need to discuss the articulated in Senate. “They have to draw a law to eliminate EPS and I think that is the main argument, because everything else can really be done by decree, but they do need the law to eliminate the EPS,” he added.
(See: Supersalud orders new EPS to legalize payments with providers)
The elimination of EPS can only be done by a law, not by decree, which explains the insistence that the Senate discusses the articulate.
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Political tension
The future of the reform promoted by the National Government entered into a stage of political tension in Congress. Sectors close to the debate warned that the Executive already prepare strategies to overcome an eventual sinking in the Seventh Commission, scenario that would mark a turn in the legislative discussion.
For Augusto Galán, “The National Government will use all the tools to try to press on the wayS ”, remembering that there is a recent antecedent in the process of labor reform.
The legislative precedent occurred when, after the fall of the project in a commission, he appealed to the Plenary of the Senate to authorize a new study scenario. “That is a tool that can eventually try to use to appeal an eventual sinking of the reform in the seventh commission,” he explained.
“What happened with the labor reform worked for them, but the parliamentarians already know of that strategy and will seek to counteract it. What there is is a political game from all parties”Galán said.
For the manager, the reaction of the parliamentarians will mark the course of the debate, while different social sectors will also enter to pronounce. “We are going to see the parliamentarians how they react to that and how civil society also (…) we pronounce on convenience or not. This government reform is definitely not convenient”, He concluded.
(See more: Scientific societies notice lack of consensus at work tables on the UPC)
Diana K. Rodríguez T.
Portfolio journalist
