The entry into force of a new health insurance model seeking the National Government It could generate enormous trauma in the system.
The above, according to a new analysis made by Thus we go in healthwhich indicates the entry into force of the Decree 858 and Resolution 1789 of 2025 It will force 2.3 million users (4.4% of the entire affiliated population) to change EPS in the next six months.
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With this new measure, which seeks to reorganize the insurance in 10 regions and 119 functional sub -regions, seeks to establish a New model of preventive, predictive and resolutive health. However, this report warns that the transition would bring immediate risks for patients, access to basic health services and the sustainability of insurers.
What would happen to free choice?
According to the report, one of the most sensitive aspects of the new health insurance model is the loss of the right to free choice of EPS. With the entry into force of the territorial reorganization norms (in particular Decree 858 and Resolution 1789 of 2025), Users can no longer choose which entity to join. From now on, they will be automatically reallocated based on criteria for sub -region, defined by the Ministry of Health.
In practice, this mass transfer remembers the processes of redistribution of affiliates carried out by the National Health Superintendency In the past, when insurance insurance was settled. However, unlike these cases, the current reallocation does not respond to a financial emergency, but to an administrative reorganization of a structural nature.
According to the analysis of thus we go in health, the measure generates uncertainty among patients: “Users will not only lose the EPS they chose, but do not know which entity will assume their attention. That uncertainty, in itself, already violates an essential right”
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Health
The territorial redesign does not impact all entities equally. According to simulations on Unique Affiliate Database (BDUA)the EPS of intermediate size are the most affected: Cajacopi must yield 30.5% of its affiliated population; Coosalud, 17.8%; Asmet Salud, 17.1%; and Famisanar, 13%.
In contrast, the Three great private insurers (Sanitas, Sura and Total Health) They will only lose between 1.3% and 3.8% of their users. The new EPS, meanwhile, will maintain the entire affiliation (more than 11.7 million people), due to an exception that protects entities with more than 20% national participation.
Paradoxically, small EPS, with less than one million members, are less affected. LNorma allows them to preserve their presence in the territories where they already operate, even if they exceed the maximum number of entities allowed by subregion.
Resolution 1789 introduces a structural change: authorization ceases to be made by municipality and is defined by Subregions. This means that Once authorized in a subregion, an EPS assumes responsibility for all the municipalities that integrate it, even those where they had no operational presence or registered affiliates.
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Health
While this approach seeks to rationalize insurance and improve coverage, it also generates logistics tensions. Some entities must expand their capacity in territories where they do not have infrastructure or consolidated care networks.
Examples illustrate the magnitude of change: Capresoca goes from operating in 36 municipalities to 175; Sanitas expands its coverage from 415 to 646 municipalities.
On the contrary, intermediate EPS lose territorial scope, as Cajacopi reduces their presence from 342 to 116 municipalities; Coosalud, from 297 to 143; and total health, from 442 to 291.
The greatest effects They concentrate on the areas where intermediate EPS had consolidated a good part of their operation, but do not comply with the new territorial authorization criteria.
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Health
The Northwestern regionwhich covers departments such as Antioquia, Córdoba, Chocó and part of Bolívarit is one of the most impacted: entities such as Coosalud and Cajacopi must give up a high percentage of their affiliates, which could generate pressure on care networks in these territories.
Significant effects are also evidenced in the regions East and South Centerwhere Asmet Salud and Famisanar will lose coverage in several subregions. This could affect continuity in attention for thousands of users in rural or dispersed areas, where the offer of medical services and hospital infrastructure already have structural limitations.
Although the official purpose of reorganization is to strengthen the equity and efficiency of the system, the analysis evidences differentiated effects according to the size and scope of the EPS. The massive reassignment of affiliates and the loss of free choice raised risks in the guarantee of continuity and quality of care, especially in the most vulnerable regions.
In that context, the challenge will be to ensure that transfers do not translate into interruptions in the provision of services or in greater fragmentation of the system.
Uncertainty about transfers
The reorganization process of the health insurance system keeps millions of users in uncertainty. It is not yet known precisely to which entities the 2.3 million members who must change EPS will be transferred as part of the new territorial authorization model.
As established by the regulations, The final decision of reallocation will be exclusively in the National Governmentwhich will define the destination of users based on the availability and authorization of insurers within each subregion.
He Director of the Thought Center Thus We are in Health, Augusto Galán Sarmientowarned that the process generates a “great uncertainty”, both for patients and for the EPS themselves.
“Nor do users know what entity they will be transferred, nor do the EPS know how many affiliates must receive or what will be the resources assigned for their attention”, He explained.
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New EPS
The expert said that, in the current context, marked by the government’s interest in moving towards a more nationalized model, It cannot be ruled out that a significant part of the affiliates is reallocated to the new EPS, currently the largest insurer in the country, with about 12 million users.
“If one presupposes the logic of the government, it would not be discharcha that in many parts of the country that was the priority of allocation”Galán said. However, he warned that the financial situation of the new EPS remains uncertain, and an overload in its operation could represent an additional risk for the sustainability of the system.
The analyst added that the redistribution could vary according to the characteristics of each municipality or subregion. In some cases, the government could choose to assign users to other EPS enabled locally, but so far the specific criteria for that distribution have not been defined.
“The decree is already underway, the resolution is already underway, and those decisions submit patients to a series of uncertainties without knowing where this is going”Galán concluded.
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Health
The immediate impact of these measures falls on users, particularly those that depend on continuous treatments or specialized services. The analysis warns that mass transfers could affect the continuity of medical care and timely access to essential services, especially in regions where receiving EPS do not have consolidated networks or the infrastructure necessary to absorb new affiliates.
To this is added the requirement of a transition in just six monthsdeadline that the report considers insufficient for such a magnitude process. During that period, EPS must renegotiate contracts, reorganize their benefit nets, adjust rates and adapt their technological systems.
“A process of this magnitude, in such a short time, is hardly realable without affecting health care”, Warns the report.
In that context, the massive reassignment of affiliates raises a significant challenge for the system, which must ensure that administrative changes do not translate into interruptions in treatments or greater barriers to access services.
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