The Ministry of Health and Social Protection confirmed an increase of 5.36% in the value of the Capitation Payment Unit (UPC) for 2025. This adjustment, based on inflation caused as of November 2024, responds to the impossibility of making a more precise calculation due to inconsistencies in the information reported by the EPS.
(Read: Uncertainty in the health system by UPC calculation)
According to the entity, This decision was made in compliance with current regulations and to guarantee the sustainability of the Social Health Security System (SGSSS).
The ministry explained that the EPS have the legal obligation to present reliable, clear and timely information, as required by Law 1438 of 2011. However, they indicated that irregularities were detected in the reports, including “abrupt increases in the severity and frequency patterns of health services, high medical expenses without the corresponding justification and payments for medications above the regulated price“.
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The Vice Ministry of Social Protection pointed out that the technical reserves of the EPS are handled discretionally and are not aligned with historical behavior. In this context, he recalled that in cases where it is not possible to determine the value of the UPC due to errors in the reports, The regulations establish that this is automatically adjusted according to inflation, as provided in Decree Law 4107 of 2011.
Health finances
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However, it is worth remembering that The public information issued by the Government shows that, from 2023 to date, through Supersalud the Government has intervened in nine EPSin which it has been appointed its interveners (in which it has influence due to the taking of possession), and whose number of patients already exceeds 28.6 million people.
Only the Nueva EPS, intervened in April of this year, has 11.3 million patients, followed by Sanitas, which reports 5.7 million members; Coosalud, the most recent (November 22) has 3.2 million members and Famisanar has 2.7 million linked people.
According to the portfolio, This is not the first time that inconsistent information from the EPS forces this measure to be taken.. For example, in 2010, the Health Regulatory Commission determined that, in the absence of reliable data, UPC adjustments should be based on caused inflation.
Furthermore, in 2011, the Superintendency of Industry and Commerce sanctioned the Acemi union and several EPS for manipulating data to distort the value of the UPC, a fact confirmed by the Council of State in a ruling of July 2023.
(See also: Acemi says that the quality of health services requires a well-adjusted UPC)
Despite the resources allocated, The Ministry also denounced that the EPS failed to comply with the constitution of mandatory technical reserves. In 2024, $82.4 billion were delivered for UPC, but irregularities in its management led to filing a popular action lawsuit against these entities.
“Where are the resources of the technical reserves?” questioned the portfolio, warning that this non-compliance directly affects the sustainability of the health system.
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They emphasized that increasing the UPC beyond inflation with inconsistent data would be an irresponsible measure that would put the National General Budget at risk. “The commitment is to transparency, the protection of public resources and the guarantee of equitable access to health services for all Colombians.“, they concluded.
