health reform
Acemi, an organization that unites various EPS, expressed its concerns about the bill that will be debated in Congress.
11/4/2023
The Colombian Association of Comprehensive Medicine Companies (Acemi), which brings together several EPS whose majority of the population is from the contributory regime, published a new analysis on the health reform that the national government is promoting in Congress.
Although the bill underwent several changes in the wording of the paper for the first debate, Acemi emphasized that there are points that remain the same as the initial proposal that had been originally filed on February 13 of this year.
To begin with, they pointed out that according to the new text of the bill, it is insisted that the Ministry of Health intends to “eliminate the insurance model”, since it proposes that there be a single payer within the health system. That role, which today is assigned to the EPS, would begin to be carried out by the Administrator of the Resources of the General System of Social Security in Health (Adres).
This, argued the EPS association, would imply that in practice these entities would disappear and patients would have to enroll in Primary Care Centers (CAP). To this extent, they warned that the possibility that patients have today to choose autonomously the insurer that will guarantee access to health services would end.
“By creating a state monopoly, the possibility for affiliates to choose their insurer is eliminated. The choice of a treating physician or a service center is a limited conception of this right”, explained Acemi.
It is worth mentioning, however, that the national government and the Minister of Health, Carolina Corcho, have argued that the EPS will not disappear, but will become Health and Life Management Entities, which would continue to have some functions of the EPS, such as management of health risk and the articulation of provider networks. But to the EPS that idea has not sounded familiar.
“The figure of Health and Life Managers does not solve a structural problem: there is no agent with the capabilities to carry out comprehensive health risk and financial risk management, with which the country’s health results in the medium term, the sustainability of the system and the advances in equity (including low out-of-pocket spending) are seriously compromised and there would be a fiscal risk for the Nation”, Acemi pointed out.
The EPS have considered that this will result in the elimination of the insurance, which in turn would imply that the financial risk would fall on the patients. “Since there is no EPS anymore, Colombian households will have to finance additional or unexpected charges,” Acemi warned in his analysis.
The union organization also asserted that the new articles still do not resolve the factors that cause the greatest number of complaints raised by patients that have to do with opportunity in access to health services.
“By dividing the levels of care, and without a person responsible for comprehensive health and financial risk management, it is to be expected that the two problems will worsen,” Acemi indicated.
The controversial creation of regional funds
One of the health reform proposals that has generated the most controversy is the creation of a series of regional funds for the ADRES. As the plan is for this entity to direct the resources to the clinics and hospitals, the Government has indicated that there must be funds in the regions that allow the money to be distributed equitably throughout the national territory.
But the idea has received strong criticism, because Various sectors fear that these funds will be permeated by the political dynamics of each region and this, in turn, will lead to an increase in corruption within the health sector.
“Financial fragmentation through different funds and accounts hinders operational and administrative management. The participation of the different Funds in the total resources managed is not specified, in such a way that it is not understood how they will be distributed. The nature of account funds does not change the approach or the risk of bureaucratization: Fosyga was a fund with more than 400 employees”, Acemi pointed out.
Likewise, he expressed his concern about the suitability of the Adres to assume all the functions that the health reform would assign to it if it is approved. And he pointed out that this entity has had problems correctly performing the functions it has today.
Finally, the union organization explained that having a limited fund of resources can put patients at risk, especially those with high-cost conditions.
“The presentation did not elaborate a rigorous and comprehensive analysis of the projects presented for accumulation. Although some articles from other initiatives are added, it does not respond to a conceptual exercise of building a coherent, technical and concerted article.Acemi concluded.
The document with Acemi’s analysis was sent on April 10 to the congressmen of the seventh committees of the House of Representatives and the Senate, which are in charge of health sector issues.