EPS union requests to review health sector reform decisions

EPS union requests to review health sector reform decisions

Gestarsalud, the union that represents 11 EPS of the subsidized regime, which cover the health of more than 20 million people, expressed concern about the statements and messages enunciated by the Minister of Health, Carolina Corcho, in the sense of the possible non-payment of the adjustments to the maximum budget mechanism that are pending for the year 2021 and the decrease in resources for insurance for the year 2023.

(Will the EPS disappear? This is what is explained from the Ministry of Health).

“These two decisions of the Ministry of Health, which were raised in the session of September 14 in the seventh constitutional commission of the Congress of the Republic, would seriously impact the guarantee of the right to health for Colombians, especially for the most vulnerable, and would expose the EPS to a greater financial imbalance risk”said the union.

On the one hand, there is the non-transfer of pending resources due to the temporary mechanism of maximum budgets for the payment of services and technologies that are outside of what is covered by the Capitation Payment Unit (UPC), which have already been provided to the population in 2021 with the due supports before the Ministry of Health and the Adres.



According to the information that rests in the Ministry of Health, In 2020, more than 2 million services and technologies were provided that were not financed by the UPC and were already recognized under the maximum budgets of the entities responsible for insurance. In 2021, nearly 2 million services were recognized with these resources and in the first half of 2022 there were nearly 700,000 services and technologies, which would represent a possible neglect of the same or greater volume of prescriptions for users in what remains of this validity.

On the other hand, there is the announcement of the decrease in resources to finance the UPC in 2023 in the General Budget of the Nation, which would go from 14.1 percent, as estimated as necessary by the Ministry of Health itself, to 12 percent.

(Acetaminophen, tramadol and other medications that are missing).

That is, a decrease of 2.1 percentage points. This in absolute numbers would mean reducing the values ​​of the insurance item from 4 to 2.2 billion pesos, without taking into account that for the year 2022 the increase that was applied to the UPC was 5.6 percent and today inflation reaches more than 9 percent.

It is worth remembering that the methodology for calculating the value of the UPC has been built and improved over 17 years and has been subject to assessment, analysis and generation of evidence by national and international academic, scientific, economic and social authorities and is considered an advance of the country.

“Not having the maximum budget resources that exceed the initial calculations made for the year 2021 and that have already been duly provided to the affiliates, as well as the decrease in resources for insurance for the year 2023, represents for the EPS a deficit in the availability of the money required to continue guaranteeing the provision of services and health risk management, but also an affectation for the IPS and providers in the flow of resources throughout the national territory”added the union.

According to Gestarsalud, “There is no doubt that the users of the health system will be directly affected, both in urban and rural areas of Colombia.”

(The proposal of the Ministry of Health in the face of a shortage of medicines in the country).

Finally, the union stated that “For all these reasons, we ask the Ministry of Health to review the decisions announced in the presentation of the budget project for the 2023 term before the Seventh Constitutional Commissions of the Congress of the Republic. Not having sufficient resources for financing and the flow of resources for the entire service chain puts the guarantee and effective access to services at risk and increases inequalities with its consequent negative effect on the burden of disease and health conditions. and life of Colombians”.


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