The seventh bulletin of the Así Vamos en Salud Financial Observatory has revealed an alarming panorama for the General Social Security System in Health (SGSSS) of Colombia. Financial losses, growing citizen dissatisfaction and an underfunded budget for 2025 reveal the structural fragility of the health systemcompromising sustainability and quality of service for millions of Colombians.
(See: Minsalud details the inconsistencies of the EPS for the calculation of the UPC)
According to the report, as of the third quarter of 2024, the Health Promotion Entities (EPS) recorded operational losses amounting to $3.1 billion. Of this total64% corresponds to the contributory regime, which shows a marked vulnerability in the financial scheme.
Besides, EPS equity is in negative territory, with a deficit of $7.1 billion, reflecting a critical decapitalization that limits its operating capacity. “The financial situation of the EPS is unsustainable. Massive decapitalization puts health care and services at risk,” the report warns.
(Read also: Rasa Foundation, on the situation of the health system: ‘the Government does not listen to us’)
Access to health services also presents difficulties. Between January and November 2024, more than 1.4 million PQRS were registered, which represents an increase of 20.07% compared to the same period in 2023.
91% of these are related to barriers to access to health services and technologies. This trend has led to a 25.4% increase in the number of guardianships filed by citizens to guarantee their fundamental health rights.
(See more: Patients Colombia requests the Attorney General’s Office to protect the fundamental right of health)
“The increase in guardianships reflects citizens’ distrust in the administrative mechanisms to resolve their health needs“says the report, highlighting the growing dependence on judicial mechanisms to access basic services.
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According to the think tank, the outlook for the year 2025 is not more encouraging. The Capitation Payment Unit (UPC), which finances health services, It started with an estimated deficit of $9.2 billion. This imbalance seriously compromises the financial sustainability of the system.
(See: Government warns that fiscal reality limits a further increase in the UPC)
The increase in the UPC was 5.36%, well below the 16.9% expected by the sector, which worsens the financial crisis. “The insufficient adjustment of the UPC not only perpetuates liquidity problems, but also limits the system’s ability to respond to the growing demand for services“, indicates the bulletin.
In addition, the spending budget allocated to cover the maximum budget of 2025 is $502,000 million. This figure is clearly insufficient when compared to the $2.3 trillion executed in 2024 until November. Added to this is that the budget for adjustments from past periods amounts to only one billion, an insufficient amount compared to the debts accumulated since 2022.
(Read more: President Petro refers to the irregularities in data presented by the EPS)
“The defunding of the maximum budget is a latent risk for the provision of services, especially considering outstanding obligations from previous years.“warns the report.
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Deficiencies in the quality of information
Another factor that aggravates the situation is the lack of quality and completeness in financial reports. The New EPS, which concentrates 23% of the system’s affiliates, has presented incomplete reportsmaking UPC calculations and projections difficult.
(See: Right to petition seeks to revoke resolution on UPC by 2025)
It should be noted that this entity was intervened by the National Health Superintendence in April 2024, which has affected its internal processes. “Deficiencies in financial information hinder proper planning and allocation of resources. It is essential to improve the quality and timeliness of data for effective management“, the report emphasizes.
The years 2022, 2023 and 2024 have been marked by multiple interventions to entities in the sector, which has impacted the quality, timeliness, completeness and reliability of the information necessary for the calculation of the UPC.
(Read more: Bad calculation by the UPC condemns health to start 2025 with a serious deficit)
For Así Vamos en Salud, this situation generates distortions that make decision-making and financial planning difficult. “It is essential to evaluate and correct factors that affect data quality to ensure informed and sustainable decisions.“, concludes the Observatory.
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Call to action
The Así Vamos en Salud newsletter concludes with a call to decision makers, actors in the health system and citizens to reflect and act on the measures necessary to overcome this structural crisis.
(See more: The inconsistencies detected by the Minsalud in the data reported by the EPS)
Financial sustainability and the guarantee of the right to health depend on concrete and coordinated actions that make it possible to correct the system’s deficiencies. “The health sector requires structural reforms and brave decisions to guarantee its viability and the well-being of the Colombian population.“says the report.
This is taking into account that not only the financial sustainability of the sector is increasing its uncertainty, but also, the reform that is currently being debated in the plenary session of the Chamber and that will soon resume discussions in the chamber.
(Read:Afidro warns that the UPC should have increased to 16.4%)
