THE COLOMBIAN
In a devastating 17-page document, in which they detail their objections to the healthcare reform, four senior officials of the government of Gustavo Petro drew attention to the initiative costs and the risks it poses to the stability of the system. The document –which allegedly tried to be hidden from public opinion– also highlights the fractures and frictions that exist within the cabinet due to the controversial project of the Minister Carolina Corcho.
Behind the document, which was commissioned by Petro himself, as revealed this Sunday by the Change Magazineare the finance ministers, Jose Antonio Ocampo; Education, Alexander Gaviria; Agriculture, Cecilia Lopez; and the director of National Planning, Jorge Ivan Gonzalez. It is, precisely, the bloc within the Executive that is considered more technical than ideological and that he has been formulating criticisms of the reform. (See document at the end of this article)
Indeed, in the document –which was presented to both Petro and Minister Corcho–, the four officials warned that the articles entail difficulties on several fronts and, along these lines, warned of financial difficulties; insisted that a mixed insurance model be favored (that is, that the EPS does not end and there is not a total monopolization of the State), and until the processing of the project should be done through a statutory law and not as an ordinary initiative, despite the fact that Petro and his squires in Congress opted for the second path.
In the first place, from the Treasury portfolio, Minister José Antonio Ocampo argued that, as it is proposed, the project “is not compatible” with the medium-term fiscal framework and that it is necessary to specify the fiscal costs of the initiative and the source of additional income that will be required for its financing. For the ministers, there is concern against the eventual fiscal impacts of the project and its implications in the General Budget of the Nation.
“The Ministry of Finance takes into consideration that the project under analysis, if sanctioned as a law, would have an impact on the Nation’s finances,” reads the document, which specifies that, with the proposed reform, spending on primary health care would grow, on average, $2.5 trillion each year.
According to calculations, with the reform, additional expenses for primary care would go from $16.9 trillion in 2023, to $31.3 trillion. That is, an increase of more than $14 billion. However, they explained that without the reform, the cost would only be $2 billion. In addition, they warned that the project poses a increase in spending for infrastructure and endowment of more than $1.2 trillion between 2023 and 2030, to which is added a cost of labor formalization for workers in the sector that in 2030 would exceed $4.8 trillion.
“In conclusion, if all the expenses proposed by the reform are carried out, the fiscal cost of the initiative would be, for the first year, around $16.91 billion additional and, for the second, of An additional $21.8 billion. Between 2025 and 2028, expenses would increase, on average, by $2 trillion a year,” they warned.
“Mixed insurance model must be maintained”
Secondly, the ministers go to the nut of the reform: the future of the EPS. Along these lines –contrary to what Petro and Corcho have proposed–, they insisted that a mixed insurance model social in health. Also, what is necessary specify the responsibility of the State in comprehensive health care through a financial and health risk management system.
They even proposed an article in which they not only ratified the mixed insurance model, but also established the function of the so-called Integral Resolutive Primary Care Centers (CAPIRS), considered the backbone of the project as they will be in charge of health care and disease prevention.
“It corresponds to the Administrative Entity of Health System Resources (ADRES) and Health Promotion Entities (EPS), health risk management, the articulation of services that guarantee effective access, the guarantee of quality in the provision of health services and representation of the member before the provider (…) Primary health care will be provided through CAPIRS, which are institutions that provide health services of a public, private or mixed nature”, reads the article written by the officials.
In front of health territorialization process that is being sought through the CAPIRS, the ministers indicated that, although progress must be made in various regions and deepened, it must be keep up the competition (of the EPS) in those places where conditions allow it, for example cities”.
The third point is related to a discussion that the Minister of the Interior, alfonso pradaand the President of the Senate Roy Barreras, They had settled: process the reform as an ordinary law and not as a statutory initiative, which demands more requirements, such as an absolute majority.
According to the ministers, to the extent that The project modifies norms related to the fundamental right to health, should be processed as a statutory law: “The bill must address the procedures and special conditions of statutory laws, regardless of whether some of its provisions have the character of ordinary laws.”
Finally, in addition to noting that at some points the project would imply prior consultation in certain communities –for example indigenous people–, The ministers describe as unnecessary that there is a precise point that guarantees access to health services for foreigners and tourists, as it would generate a “high financial risk for the system”.
According to officials, the Constitution itself already states that no one can be denied health care and the offering of services, but with the project, guarantees would be extended to inhabitants who cannot be considered as part of the national territory. Therefore, it would be “necessary and feasible” to continue requiring them to purchase health insurance.
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