A study carried out by the Ministry of Health and the Administrator of the Resources of the General System of Social Security in Health (Adres) would have shown errors and inconsistencies in the data provided by the Health Providing Entities (EPS).
(Read more: Criticism grows against the increase in the UPC for 2025)
As reported by the National Government, the analysis took place in November 2024 and was carried out as a comparison exercise to examine the calculation of the Capitation Payment Unit (UPC), indicator to which an increase of 5.3% was applied for this year.
Among the results highlighted in the report includes an increase in the reported frequencies of some health services. Here increases are highlighted in activities such as home care, which presented an increase of 97.8% between 2022 and 2023; radiology, with a growth of 79.7%, and clinical laboratory, with 77.9%.
They were also observed increases in emergencies (51.1%), hospitalization (39.3%) and general surgery (24.4%).
According to the Executive, these increases would contrast “with a practically unchanged installed capacity in the same period, as evidenced by data from the Registry of Human Talent in Health (Rethus), which reported an increase of 3.1% in the number of general practitioners and an increase of 3.6% in the capacity of general medicine offices”.
(Read more: Insurance unions ask for technical tables to talk about the increase in the UPC)
Another inconsistency highlighted by the research has to do with cancer-related services. The study mentions that the frequencies associated with these activities increased by around 53% between 2022 and 2023. This, “despite the fact that the incidence of this disease only grows at an average rate of 4% annually in the country.”
The report also indicates that 3% of the medications reported did not have a valid health record and that 23% were not associated with purchases registered in the Drug Price Information System (Sismed). Likewise, it was detected that 5% of medicines exceeded the maximum regulated prices, which generated an additional cost of 138,000 million pesos to the system.
As part of the recommendations derived from the study, the Minsalud and Adres highlighted the need to implement a more robust methodology for calculating the UPC. In addition, to carry out a strict purification of the data reported by the EPS to identify, correct inconsistencies and validate the information against external bases.
Health
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Criticism of the increase in the UPC
The adjustment for 2025 of the UPC has been questioned from different fronts. The criticism is based on the fact that the percentage set, 5.3%, not only would not meet the health care needs of the populationbut it would also affect the other actors that make up the system.
Voices from the health sector have also indicated that it is insufficient to cover the increase in the minimum wage established at 9.54%. Same reason why it has been requested to review the calculation and make a readjustment.
In this sense, it has been considered essential for the Government, together with health service providers, to make a more precise estimate of the real operating costs, considering the increase in demand for services and the increasing associated costs.
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