In a report, the Colombian Association of Hospitals and Clinics (ACHC) revealed that the debt accumulated by 221 health institutions in Colombia It went from $16.09 trillion in June 2023 to $16.8 trillion in December of the same year.
(See: Ordinary or statutory? The paths contemplated for the processing of health reform)
This increase of approximately $705 billion, equivalent to 4.38%, reflects a growing financial crisis in the sector. Furthermore, 54% of this debt is in arrears, with delays of more than 60 days.
Marcela Brun, Public Policy Advisor for Finance, Health and Education, said in an interview with EL TIEMPO that The deficit in the health system is not new, but the current situation is critical due to the lack of management of the current government.
(See also: Analysis: Is the health system in Colombia in ‘intensive care’?)
“Previously, the Ministry of Health and the Ministry of Finance were constantly managing and making budget adjustments. Now, the government is downplaying the problem and does not seem to do anything about it.“Brun said.
Health finance
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Discontent with the health system has resulted in a 42% increase in guardianships during the first four months of 2024according to the Así Vamos en Salud observatory. Even Augusto Galán Sarmiento, former Minister of Health and director of the observatory, attributes this increase to the delay in scheduling appointments, the lack of medications and deficiencies in medical procedures.
(Read more: How the health market is preparing for the changes that a reform of the system would bring)
Hospitals, facing increasing bad debts, are particularly affected. Juan Carlos Giraldo, president of ACHC, explained that the debts come from both liquidated EPS and those in operation, in addition to the outstanding debts from the State. The delinquency rate is largely due to the lack of resources in the EPS due to the lack of funding of the Per Capita Payment Unit (UPC) and state debts.
In search of solutions, The sector has repeatedly asked the government for a recalculation of the UPCbut so far, the response has been insufficient. Former Health Minister Alejandro Gaviria urged the government to design liquidity instruments and catch up with maximum budgets.
(See: What is the Primary Health Care Account proposed by the Government in its new reform?)
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The financial situation of the health system in Colombia reflects a considerable challenge. By the end of 2023, the total volume of debt of the Health Promoting Entities (EPS) of the contributory regime amounted to approximately $8.4 billion, with a default rate of 52.2%This indicates that more than half of the debt is not being paid on time, creating significant stress on the system.
(Read: Health reform: what changes does the document that would replace the previous project contain?)
Of the total debt, 81.1% corresponds to 13 EPS in operation, totaling some 6.8 billion pesos, while the remaining 18.9% corresponds to 16 liquidated EPS, with a debt of $1.6 billion, all in arrears.
To address this problem, Decree 489 of 2024 has been implemented, which introduces a mechanism for the direct transfer of resources. The System Resources Administrator (Adres) has allocated $44.8 billion in the last six months directly to hospitals, clinics, service providers and health technologies.
(Read more: Voices from the health sector present a proposal for reform of the system)
This adjustment aims to alleviate the burden on the EPS portfolio by channeling funds directly to Health Care Providers (IPS), instead of to intermediary EPSs such as Nueva EPS and Sanitas.
