One of the most important reforms of the Gustavo Petro government has already reached Congress. Is about health reform. A project that has been widely debated and criticized by public opinion.
(Read: Petro will regulate public services: Here’s what it could do.)
The proposal of the Ministry of Health dedicates an entire section to the transition and evolution that the health system will have in the country. One of the main points is prior consultation with the traditional authorities of the indigenous communities for the reorganization of the Social Security System in Health, where health services and organization in their territories will be regulated.
It clarifies, in turn, that “the excepted and special regimes of the Health System will continue to be governed by their special provisions“. This implies that the teaching regime will remain in force and will be exempt from the provisions of the law.
health reform
Ministry of Health
Also, it indicates in article 47 that private companies whose corporate purpose is the sale of prepaid or voluntary health plans, they will be able to continue operating and marketing their services under the rules and standards of operation, financing and provision that govern them.
(Read: Health reform, debated in extraordinary sessions in Congress).
The project also indicates that from now on the State social enterprises will adopt the name of State Health Institutions, ISE, and will implement the new regime in the following four years. In addition, They will maintain the uninterrupted provision of health services under their responsibility.
“The competent national and territorial authorities will gradually and progressively advance the transformation of national and territorial State Social Enterprises – ESE into State Health Institutions – ISE. For this purpose, the national government will determine the phases and periods of transformation based on geographic, population and regional criteria, prioritizing dispersed populations.“, indicates the reform.
Now, about the public institutions that provide health services and are being managed by private operators, orOnce the contractual deadlines are met, they will be converted into ISE.
(In addition: With the health reform, is it going back to a figure similar to Social Security?).
In the midst of the transition, they clarify that no person will be left without health protection, affiliation or affiliation to the Comprehensive and Resolutive Primary Care Centers in Health, CAPRIS.
“In no case during the transition period can any person in Colombia be left unprotected from the effective enjoyment of the right to health,” they state. For patients in critical condition or with treatments that cannot be interrupted, will continue to be served by service providers while making the move to the new system. Medications will also be guaranteed as well as the continuity of treatment.
“The Health Promotion Entities that are not in the liquidation process on the effective date of this Law, will agree, based on the regulations established by the National Government, the rules for the delivery of the affiliated population to the new social health insurance.“, they explain.
health reform
Ministry of Health
These entities nor will they be able to suspend their affiliation operation and health care until the delivery of its affiliates to the CAPRIS. “The Health Resources Administrator, ADRES, will carry out the recognition and payment of the Capitation Payment Units and other resources of the social health insurance,” they state.
(Keep reading: Health reform confirms the fears of the EPS).
The Government also explains that will carry out a process of territorialization of the EPS concentrating its operation in cities and departments that have a greater number of affiliates and more organization in the provision of services.
For this transition process, the following rules will apply:
1. for each household, all its members must be affiliated with the same Health Promotion Entity.
2. In a territory where there is only one Health Promotion Entity, this may not reject the insurance of the existing population in the same, as long as its operation is viable.
3. In the territories where there are no Health Promotion Entities, the New EPS, will preferably assume the insurance or, failing that, those Health Promotion Entities with the capacity to assume the operation in those territories will do so. For the territorial reordering of affiliates during the transition, the New EPS or the existing EPS may assume the affiliates of Health Promotion Entities liquidated or incapable of serving their affiliates.
4. The New EPS will contract the Comprehensive Resolutive Primary Health Care Centers -CAPIRS, if necessary, or will assign the population affiliated to it in such Centers that are operating under the rules of the new Health System, in the subregions or municipalities prioritized in its implementation.
(In addition: Members of a single household must be enrolled in a single EPS?).
5. The New EPS will contribute to the organization of the provision of health services within the framework of social health insurance, will facilitate its infrastructure in each territory to organize and make the transition towards the organization of the territorial registration of the population and the structuring of the reference and counter-referral system, the formation of the CAPIRS Comprehensive and Resolutive Primary Health Care Centers, as well as the organization of integrated and comprehensive networks in the territories that the Ministry of Health and Social Protection and the authorities of the territorial level determine.
6. From the effective date of this Law, There will be no authorization to enter the Health System for new Health Promotion Entities.
On the budget, they indicate that lThe regulations will have to adjust to the resources of the General Budget of the Nation.
Finally, it establishes that “heThe Health Promotion Entities that remain in the Health System during the process of transition and evolution towards the new System, will progressively split their institutions that provide services, according to the implementation plan discussed in this article. In accordance with the regulations of the Ministry of Health and Social Protection, the process will be determined.“.
(Keep reading: Health reform: reactions to the project filed by the Government).
The Government ensures that in a maximum period of 6 months it will establish the regulations of the law for the formation of the National Health Council and in a maximum of one year that corresponding to the operation of the Health System. In addition, explains that the President will have some extraordinary functions for 6 months.
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