The Capitation Payment Unit (UPC) It is the annual value recognized for each of the affiliates of the General Social Security Health System (SGSSS)both from the contributory and subsidized regimes. This premium has the objective of covering the provision of services and technologies for each patient.
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As is common, each year, the value of this unit must grow taking into account various indicators such as the aging of the population, the costs of the system, the population exposed to risk and also inflation.
Different comments have been made regarding next year’s calculation. Several actors have published their estimates, including the president himself, Gustavo Petro, has given indications of what would increase the value of this health indicator.
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In fact, the President assured through his social networks that the Capitation Payment Unit must have the inflation index as a reference. “Since the financing of preventive and primary care is not allowed through the UPC, by judicial decision; This must have a different transfer system and be used exclusively for this purpose.”, he opined.
For their part, unions such as the National Association of Businessmen of Colombia (Andi), published a document in which suggest that the increase in this indicator for 2025 be 16.9%, with the objective of stabilizing the financial crisis that the Colombian health system is currently facing..
Faced with this, Bruce Mac Master, president of Andi, indicated that for several years the resources have not been sufficient, reason that has led to the accumulation of a deficit that has the sector in crisis today.
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“Any lower figure implies a great risk to health and life. It is not reasonable to make health a field of political dispute, no matter how much money it represents. You have to focus on caring for people and ensuring patients are cared for. I hope the government has the maturity and responsibility to seriously assume its constitutional obligations to provide health to Colombians.” said Mac Master.
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It should be noted that for this year, The UPC had an increase of 12.01% supported by inflation, which at that time closed at 9.73%added to 2.28% inclusions for updating services and technologies.
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Likewise, the union explained that this estimate does not take into account the missing resources that have accumulated in the system between the periods of 2022 to 2024, that this year alone there is already missing money of at least $10.9 billion.
“Failure to increase the UPC to sufficient levels guarantees that a health crisis will occur in terms of care and operation of the system. It is important to reiterate that it is the responsibility of the national government, headed by the ministries of Health and Finance and the National Planning Department, to define the increase in the UPC that guarantees the operation of the health system.“, they said.
Now, another point that generates concern about the UPC’s decision, which must be announced no later than December 31, It has to do with the increase in the minimum wage, which by presidential decree remained at 9.54%.
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According to the president of the Colombian Association of Comprehensive Medicine Companies (Acemi), Ana María Vesga, Of every $10 of health spending, between $6 and $7 are dedicated to remunerating human talent.
In that sense, the union leader assured that “A 9.5% adjustment in the minimum wage will have a direct and significant effect on the cost of health by 2025. The UPC adjustment must recognize this”.
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Along the same lines, the representative to the Chamber for the Democratic Center, Andrés Forero, highlighted that the discussion on the UPC in Colombia is worrying and critical, after the announcement of the increase in the minimum wage.
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Specifically, the congressman pointed out that “After the 9.5% increase in the minimum wage for 2025 decreed by Gustavo Petro, the discussion about the increase in the UPC becomes even more critical. If the president insists on raising it only to the level of inflation, he will end up bankrupting the health system and causing deaths.”.
Even actors such as María Claudia Lacouture, president of the Colombian American Chamber of Commerce, indicated that The definition of the UPC for 2025 is a critical issue that requires responsibility and coherence.
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“This must be adjusted to the real needs of the health system, considering factors such as inflation, the exchange rate and increasing costs. Maintaining a lag in resources deepens the budget crisis, affecting access to essential services, treatments and medicines. Improvising would have serious consequences for millions of Colombians who depend on an adequate and timely system. It is urgent to close this gap to guarantee the sustainability and quality of the service”, he noted.
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What does the UPC need?
Acemi inferred that correct technical and actuarial modeling of health risk is essential to safeguard the right to health of Colombians. The precise quantification of the risk premium represented by the UPC is essential to guarantee both the financial protection of households and the adequate financing of the services and technologies included in the Basic Health Plan (PBS).
(Read more: Andi estimates that the UPC should grow 16.9% by 2025, thus stabilizing the operation)
Therefore, they assure that this calculation must include various fundamental elements to guarantee its sufficiency. Among them is the consideration of the population exposed to risk, lpending compensations from previous periods, and an inflationary update that reflects both the inflations causedlike those expected in 2024 and 2025.
Furthermore, they predict that the so-called “inflationary trend” will be around 11.3%, so the exercise must incorporate an analysis of the frequencies of use of the system through a statistical model that determines its long-term trend.
Estimates from the union and the Ministry of Health suggest that this annual variation would range between 6% and 7%. Besides, An adjustment must be made corresponding to the services that have already been provided but have not yet been reported by the EPS (known as IBNR), which represents approximately 3.6% of the system’s annual costs according to MSPS data.
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However, an incorrect determination of the rate could exacerbate problems of financial insufficiency that already affect the sector. According to financial figures from September 2024, The system has an aggregate accident rate of 108%, which means that for every $100 received for UPC, the expense amounts to $108.
This accumulated deficit has generated a shortfall close to $6.3 billion in the last three yearsnot including administrative costs, according to calculations by Acemi and other experts on the subject.
