Is the collapse of the health system coming?

Points of strength and weakness

The Colombian system combines three characteristics that constitute “good practices” in light of a report World Health 2010:

• First, Colombia has chosen to universalize solidarity insurance coverage as part of social security, which the entire population can access on the basis of their ability to pay, either through contributions to the contributory system or through free accession to the subsidized system.
• Secondly, contributions are obligatory for workers, pensioners and other persons who have the ability to pay, so although it is possible to obtain private insurance, in all cases it is necessary to contribute to the system, which enhances the public or social nature of insurance. .
• Third, Benefit plan Which the Colombian system guarantees is unique or equal for all residents. It includes 95% of the medicines and procedures available in the country, and is financed from a single national fund (ADRES), in which contributions and financial resources are pooled, especially from the state’s general budget and the general system of contributions.

But the Colombian health system suffers from shortcomings that need to be addressed, either through… Reformation Deep or gradual changes.

Although the system may stand out in its overall design and look-like Systems In more developed countries, such as Germany, the Netherlands and Israel, the promise of universal coverage must be fulfilled at the meso and micro levels, that is, in regions and with the participation of multiple agents, from both the public and private sectors. There are difficulties in access for residents, as well as risks of inefficiency and corruption, which also threaten public hospitals controlled by political agents.

For this reason, there is a tension between the goals of the system in terms of health coverage and improvement on the one hand, and the incentives of those involved in insurance management and service delivery on the other hand.

The reform should lead to improved management of the Ministry and regional entities and the adoption of effective accountability mechanisms. Oversight bodies must play their corresponding role, focusing on the technical practice of inspection and monitoring, rather than attracting media attention and providing vague or unsubstantiated reports.

Financing problem

Without denying the problems plaguing the system, we must remember that public funding has increased significantly.

Although universal coverage was not achieved in 2000 (as Act 100 stipulated), it became a practical reality after 2012, when the covered population exceeded 95% and the benefit plan for contributory and subsidized systems was finally standardized. The search for universal coverage was reinforced by the decision of the Constitutional Court T-760 from 2008 legal health law, Law 1751 of 2015.

However, in these last twelve years, and especially since the issuance of Law No. 1438 of 2011, the system has emerged Important changes Removing barriers to access to health and ensuring access to it as a basic right. This means greater requirements In terms of financing, thus increasing public spending as a proportion of GDP for the following years.

This is where the system presents difficulties Financial sustainability: We are under pressure to respond to the increase in demand and availability of new technologies, which both providers and residents are willing to adopt, but at a very high cost.

The above is reflected in two aspects of financing that are being talked about now and in which we need transparency of information and calm judgment to know the truth about the numbers:

-First of all, the EPS receives the unit payment per capita (UPC), which can be understood as the health insurance premium covering the services and medicines that are part of the benefit plan. The EPS budget results from multiplying the UPC values ​​by the number of members, and as such must ensure the care of the dependent population.

In 2024, the contribution system's EPS receives an average of $1,444,086 per year per member; For a supported system, this amount is $1. 256. 076. According to various studies or scenarios, including balance sheets shown by earnings per share —, UPC is insufficient; Covering the costs of care requires extraordinary adjustment and constant monitoring to ensure balance.

-Secondly, to finance care not included in the UPC-supported benefits plan, there is an additional resource that until 2019 was called “recovery” and since that year it has become the “maximum budget mechanism”. It was a payment transfer the previous To payment old post, Trying to contain their growth and reduce EPS risks rather than simply recognizing the values ​​they provide to the public health social security system resource manager (ADRES). In this regard, and in the context of following up on Judgment No. T-760, the… Constitutional court The government has just ordered that payments to EPS be updated for services already provided; This would be an acknowledgment of a debt from the past three years that could approach four billion pesos.