Dismantling the health reform

Health Minister Carolina Corco revealed the health reform proposal that “the change is very simple, that the money arrives perfectly, without intermediaries, because the resources are limited (…) with a public information system. Avoid vertical integration” (https://elpais .com/america-colombia/2022-09-15/). In other words, “No more EPS,” he wrote on Twitter (02/18/22). A statement, in and of itself, that feels like a leap into the void that must be rectified by Bill 100 of 1993 Amendment Bill.

It’s a complicated topic. Health cannot be a commodity or a financial act, but any alternative must adhere to the principles that govern this sector which, if avoided, will make the cure worse than the disease.

The level of prevention and basic care (PAB) is subject to economies of scale, so marginal cost, which is the cost of the last person served, falls only in overall management schemes. From the second level of care up, up to the fourth level, in surgeries, special treatments, orphan or chronic diseases, expensive or terminal treatments, the costs are increased to the value of the unit, and if your benefit is by private health insurance services, the amount covers Expenses and internal rate of return (IRR).

What is the price? According to a report by Supersociedades of 424 IPS (Clinics and Hospitals), which billed more than 36,298 million pesos in 2021, net profit on equity was close to 15%, at the Santa Fe Foundation, Pablo Tobón Uribe, a West Foundation and the North General, and even between 20 and 29 in San Ignacio or Empanaco. Public hospitals, such as the General Hospital of Medellin (with several places closed for days), Evaristo García, Salud Sur Occidente de Bogotá or San Jorge de Pereira, are less than 5 percent (Dinero, 09/10/22). In 2018, the number of foreign capital was 3,634 and 15,160 from the private sector (NAB, p. 375), some very notable foreign capital from countries protected by the FTA. Will there be a maximum IRR?

If demand is encouraged by coverage, rights and absolute access, which is the ultimate goal of reform, prices will rise under the rigid supply of services. In fact, healthy inflation grows between 2009 and 2018 and in general more than the total CPI (Danish, CPI, Supplements).

If the public network is not addressed and expanded, which drives decent labour, reform could be, in financial terms, a shot in the foot. In 2015, when Petro closed 1,500 county services (Pinalusa later shut down 594), 76 percent of operating rooms, 51 ambulances, and 57 households were owned by IPS Private, which in 2018 was 1.7 percent. Its population is in Latin America 2.4 (same). Returning resources is a mistake and more so if you continue to distribute them in a sector that has special control and expectations for your investment return.

Without a powerful apparatus of state assistance, outside the PAB at home, the limited resources, which will come from contributions and contributory taxes and with a single dependent system, will also not be sufficient, and the surpluses discussed in EPS will be transferred. to strong reinforced IPS. Will the billing-by-service model change to a global contract, with each one according to capabilities?

Reasonable doubts arise about the future of the main EPS, La Nueva, which is of a general nature, with 8 million members and which along with five others, Sanitas Keralti, Sora, Salud Total, Famisanar and Cosalud, controls two of the three weights of the system (money, ditto). Oligopoly exists, as it does in contemporary financial markets, aided by the failure of dozens of EPS, which disappeared without repayment of the remaining debts, and the failed management of Corcho’s cabinet colleague, Alejandro Gaviria, in SaludCoop, Cafesalud and Medimás. User frustration and guardianship is growing.

There are questions about system administration, including information. Will Adres be able to process 30 million invoices? Wouldn’t the management knowledge accumulated by EPS come from a complementary role? Oversight of the system has also been defined in a collective body, the ministry, participating agents, civil society and the community. It is not appropriate to remove it from the leadership of the central government, even if a certain participatory tendency is dispensed with, and if a scheme of this kind is sought, the work of Hernández, Ochoa and Restrepo (2008) designed social control in the territory accompanied by state entities.

The “mysterious interventions” of the minister (Osechi, Mas Colombia) cast a shadow over the reform rather than the spotlight. Will it resolve doubts, panic, gloss and demands for transparency? Will it comply with the sector guidelines? Success will come if the answers are solid, it depends on rather than cracking down on political rallies.