Colombia is definitely a society sick with corruption. Every sector every activity is a space to think and create companies to cheat. Much of Colombia’s potential in innovative ventures is diverted to creating corruption ventures. In addition to being a severe institutional disorder, corruption is also a repugnant public health problem because it is a mental health issue that social scientists and psychiatry have little access to.
The health system does nothing either because it is another business of the dozens of businesses that make it up. Some cover others and others cover some, after all it is a mega business system. This text deals with a problem whose solution is the responsibility of the Ministry of Education and Justice, without the Ministry of Health being able to look the other way because, after all, it is about the professionals who will provide services in its system.
A general practitioner told me that she had not been able to do her specialization because despite having done very well in four interviews, she had not been able to win a place for her postgraduate course. With the doors closed, she also failed to contact the calanchines who negotiate quotas in private universities and in public universities. That’s how I talked to other people. Before I continue, I cannot say how many medical schools have these pockets of corruption: all, many, some?
The calanchines are in the universities and are the intermediaries between the applicants and those who internally assign the quotas.
The rates depend on the degree of reputation of the university institution. The better classified, the more expensive quotas that can reach and exceed fifteen million pesos. The lower the classification, the cheaper places starting at five million pesos.
Why is the business focused on entering medicine? Two reasons: one, because it is the race that requires the highest scores in the ICFES. So, there are applicants who did not have the best results due to the regular or poor quality of the baccalaureate; and two, because if they manage to specialize they are serious candidates to join the club of specialists who earn a lot of money. The resistance to changes in the health system is nothing more than the scare of changes in the network of licit accumulation but not exempt from abuse, discrimination, privileges and some bad practices such as those IPS that do not give receipts or do not have dataphones and thus evade to the DIAN.
The difficulties to enter some medical schools have generated another business: the Pre-Icfes, which are very expensive, provide good preparation and guarantee a good result in the exams. Afterwards, the applicant must also pay the quota to enter the undergraduate program.
Thus, a student can disburse between one and five million for the Pre-Icfes; from five to fifteen million or more to enter the undergraduate; plus the cost of tuition for the semester.
Consequently, rich students do not pay Pre-Icfes because they come from the best schools. Under these conditions, a situation of disadvantage and inequity in access is generated, which widens the inequality and inequity gaps because those who have less money pay more. Where is the ruling class and where is the State with its education system and control and justice agencies to attack this other inequality and an additional type of corruption? Where are the chancellors, deans and administrators? But the Ministry of Health must also be aware of this situation. The purchase of quotas is widely known, it is not a mystery and I am not denouncing something that is not known, but regarding which there is silence because it is also part of the individual strategy of achieving a privileged situation years later, because after all After all, they have had to study for ten, twelve, fifteen years.
This week I asked an aspirant to study medicine if she had to buy the quota. She told me that yes, it cost ten million, and that is why she is doing a Pre-Icfes to achieve a result that hopefully allows her to avoid the toll. Of course not all applicants pay. The corruption business is to make it selective and not generalized, because it ends.
However. The medical student who pays a higher or lower toll, in the end obtains the title of general practitioner and falls into the networks of the health system. If he does not manage to specialize, he remains at the level of a professional who provides a general health service as a general practitioner. A workspace is made up of a certain type of IPS, different from high-level clinics and hospitals, where they encounter another problem, not one of corruption but of quality, law and equity, because the system discriminates services according to the user’s contribution to the system. .
Patients who pay more have more services. For this reason, the IPS warn general practitioners of the number of examinations and specialists to which patients are entitled according to their category. The less contribution, the fewer exams and consultations. And if it is very low-income, it is in the hands of the doctor Ibuprofen and the funeral home.
That said, doctors in these positions cannot act with all their knowledge and run the risk of affecting their professional reputation, despite the fact that they warn “I do not guarantee X or Y examination or treatment because I do not know if they will approve it.” In the end, he only applies a part of his knowledge because the system thinks first of the costs, the invoice and the profit, that is, the business.
That is why there are magnificent general practitioners who work independently, whose treatments and diagnoses are very accurate and end up coinciding with the diagnosis and treatment of specialists. And general practitioners linked to a type of IPS that seems not to be so good, for the reasons mentioned above. Additionally, their salaries are fair or bad, and sometimes they have to suffer delays in the payment of their services.
There is a kind of social class in the system with those professionals with more training and more financial resources, who become people with very high incomes (which is not bad) and are owners or partners of important IPS (which is not bad either). ), but what is wrong is that they feed the system of inequity and affect quality because in the end they concentrate the largest mass of EPS patients, although they cannot cope because there are too many patients for few specialists. The scheme of concentration of wealth and power that characterizes societies with profound inequality is also reproduced in the health system, and in all State systems, which is why the absolute deficit in social policies extends indefinitely over time.
Additionally, the professional success of doctors has a negative impact on education because many of the best intelligences do not teach classes because they earn less than in the offices.
In short, corruption in access to education. Service quality according to what the taxpayer pays. Lower quality of education due to bad practices in access and because some of the best heads prefer accumulation to training.
The quality of the schools also fails, which is why the Pre-Icfes are another business. In many cities there is a lack of specialists. Sometimes there are only one or two for cities and territories with more than 500,000 inhabitants. A perfect wicked circle. The victim the patient. The absent state. Corruption takes course from education. All due to Law 100 that Uribe brought.
Thus, it is desirable that the preventive health scheme promoted by the new government be a source of opportunities for all medical personnel: more work spaces, fair competition, curbing bad practices, better salaries and better services to the public. , and more research because the EPS do not give weight to generate new knowledge or create health industries.