The Colombian Association of Comprehensive Medicine Companies (ACEMI) presented to the Technical Table for Review and Adjustment of the Capitation Payment Unit (UPC), convened by the Ministry of Health in Compliance with cars 007 and 504 of 2025 of the Constitutional Court, a technical report that exposes the financial deterioration of the health system.
According to the analysis delivered, Cost underestimation and the lack of appropriate verification mechanisms have resulted in progressive definanceaccumulation of debts and decapitalization of insurers.
(Read: Debt with clinics and hospitals reached $ 24 billion as of June 2025)
The Court’s mandate ordered the establishment of the UPC in 2024, to review the accumulated deficit since 2021, determine guidelines for Ex Post adjustments with defined dates and percentages, and guarantee the participation of the system actors in the process.
In his exhibition, the union said that “Legal and regulation The report of the system’s financial information is not the exclusive responsibility of the EPS, but corresponds to all system actors”
This includes service providers, territorial health addresses, pharmaceuticals, compensation boxes and professional risk administrators. According to acemi, The government has a central responsibility in the management and contrast of informationespecially in the case of intervened EPS, which concentrate about 25 million users under state control.
One of the findings presented by the Association has to do with the difficulties in the purification and validation of the costs, andIn particular those associated with patients with expenses greater than $ 100 million annually, users with more than 1,000 services per year or procedures above the average reported. According to the calculations, the elimination of these records implied cost discard for $ 13.4 billion between 2021 and 2024, which would have led to an UPC substation.
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The accident rate of the health system went from 100.8% in 2021 to 109.5% in 2024, and the Comptroller estimated it at 110.1%.
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The accident analysis showed aggravation in the 2021-2024 period. According to the methodology of the National Superintendence of Health, The indicator went from 100.8% in 2021 to 109.5% in 2024. This result is consistent with the report of the Comptroller General of the Republic, which placed it at 110.1% for the same year.
“The increase in accidents, added to the administrative expenses necessary to operate the system, have resulted in an actuarial debt of the Nation with the health system, ranging between $ 26.4 and $ 33.4 billion”, Warned the association.
The increase in debt has resulted in the decapitalization of EPS, the impossibility of constituting sufficient technical reserves, the growth of obligations with providers and suppliers and the breach of the financial requirements that have resulted in administrative interventions. TO This adds that the appropriate resources by the Government to finance the inclusion of new health technologies were insufficient in 2022 and 2023which accelerated the deterioration of the system.
(Read more: Fiscal endorsement of health reform raises more public spending and less resources)
The nation’s actuarial debt with the system ranges between $ 26.4 and $ 33.4 billion.
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Inclusions to the Basic Health Plan
In the case of medicines incorporated in 2023, ACEMI reported a missing $ 511,000 million in financing, not including logistics and operation costs. The guild questioned that the calculation of the Ministry of Health “does not follow the methodology that allows us to understand the evolution of inclusions spending”And he warned about the need for the technical estimate procedure and its results to be public and accessible to all actors.
Another of the elements analyzed was the evolution in the frequency of use of services. The report said that in 2019 434.7 million consultations were made, while in 2024 the figure reached 548.6 millionwith an average annual growth of 4.7%. According to the high -cost account, patients diagnosed with invasive cancer went from 0.4 to 0.6 million between 2021 and 2024, cases of diabetes of 1.6 to 2.3 million and those of chronic kidney disease from 0.9 to 1.2 million.
However, the Ministry of Health ignored this growth in the UPC settings of 2024 and 2025, limiting the increase to inflation percentage. For acemi, this decision reflects the “inadequate application of statistical tools that do not know the real dynamics of the phenomenon”, Which contributes to the structural insufficiency of financing.
(Read: Fomag expands its pharmaceutical network with more than 1,100 dispensing points)
In 2024, 548.6 million consultations and procedures were registered, compared to 434.7 million in 2019, with an annual growth of 4.7%.
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The guild also expressed objections to access to the information used by the Ministry to calculate the UPC. From the beginning of the technical tables, He requested anonymity to the base of sufficiency, which constitutes the basis of the calculation, as well as the possibility of replicating the exercises.
The application was denied by the Ministry of Health and Adres, who argued the existence of reserved personal data. However, ACEMI warned that the same information has been delivered to universities and research centers in different periods.
“The fact makes it impossible to carry out a technical and rigorous assessment of the information, as well as the calculation and management methodologies presented by the Ministry of Health and Adres”, Said the guild. According to the association, this lack of access limits the ability to verify complaints about apparent excesses in the reports of some EPS and has generated a climate of distrust in the official figures.
(See: Possible liquidation of the new EPS would be a ‘smoke curtain’)
The financing of medicines included in 2023 presented a missing $ 511,000 million.
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Warnings
Now, The document indicates that the Ministry has underestimated the evolution of key variables in the UPC updatethat the responsibility for the information must be shared by all the agents of the system and that failures persist in the feedback mechanisms.
In addition, he warns that “LIn insufficiency of the UPC declared by the Honorable Constitutional Court and evidence”
In that sense, the Association emphasized the need for database crossing mechanisms such as the individual service provision (RIPS), the Medicine Price Information System (SISMED) and sufficiency studies.
He also caught attention to the urgency of a budget adjustment that guarantees the sustainability of the system. “Patients cannot be sacrificed. Behind each figure there are thousands of Colombians who expect treatments, medications and attention”The guild said.
(See more: Supersalud orders new EPS to legalize payments with providers)
Diana K. Rodríguez T.
Portfolio journalist
