Financing Problems in the Health Sector: Acemi Raises Ten Points for Dialogue with EPS

2023-08-25 12:42:27

After the statements by the Minister of Health, Guillermo Alfonso Jaramillo, at a press conference this Thursday in relation to the complaints of three large EPS about their financing problems, Acemi, the union that shelters them, raised ten points for the start of the conversation that was announced with the EPS

Nobody can say that the money runs out in September, because the resources are here and they are paid in advance and in twelfths.

On July 27, the EPS Sura, Sanitas and Compensar sent a letter to the Minister of Health stating that, due to the difficult financial situation in the health sector, they anticipate serious difficulties in continuing with their operations after the month of September this same year, which is why they ask the official to meet as soon as possible.

However, in a subsequent press conference, the minister dismissed their arguments and said that he sees no reason for these entities to stop operating in the coming months, after having held a meeting with them. In addition, he stated that if they go bankrupt, he would apply the figure of direct transfer to clinics and hospitals in an emergency to overcome the situation.

“Nobody can say that the money runs out in September, because the resources are here and they are paid in advance and in twelfth parts. Each month in advance, each of the EPS is paid what corresponds to it to serve Colombians, ”he said during the press conference.

And it is that, according to these organizations, one of the factors that most affect the system and its operations is the calculation of the value of the capitation payment unit (UPC), that is, what is received by each user, since it would be insufficient to meet the Health Benefits Plan (PBS).

“The resources assigned in the general budget of the Nation are not enough to cover the general needs of the system. It is estimated that the value of the UPC in 2022 was insufficient by 8 percent with respect to the increase in the value of the services covered by the PBS. The adjustment of the UPC in 2023 did not correct this problem ”, the EPS had indicated.

In this regard, these are the 10 points that Acemi raises as starting points for the dialogue with the Government

1. The financial sustainability of the Health System is a conversation of national interest, which commits all the actors of the System and is not limited to a particular situation this year.

2. Financing problems are the product of an accumulated structural insufficiency, added to a difficulty in the flow of resources accentuated in recent years. Today old and new situations converge that must be managed by the current government.

3. The UPC is not enough to cover health spending. In 2022, for example, of every 100 pesos allocated to the EPS for payment from the UPC, they spent 102.5 pesos to care for the health of their users. This is partly explained because the calculation of the UPC is made with values past due for at least two years.

4. It is not true that the frequencies have increased by only 3%. The EPS have reported increases in frequencies between 20% and 25%, due to the post-pandemic effect and the uncertainty generated by the reform, among others.

5. Regarding the Maximum Budgets (PM), the years 2022 and 2023 have seen a substantial reduction of these resources. By the year 2022, the Ministry of Health stopped executing 313,000 million and by 2023 the resources were exhausted in the middle of the year. The principle of annuality, planning and comprehensiveness was not followed. To date, the PM for July and August 2023 and the PM adjustments for 2022 have not been turned.

6. It is necessary to advance in the implementation of the direct line of business for the services and technologies covered by the maximum budgets.

7. The recognition by the Government of the need to specifically address both issues is positive: the analysis and reconciliation of the No PBS through technical tables of the EPS with the ADRES and a space for technical discussion around the adequacy of the CPU. It is not enough that the turnover be anticipated if the resources are not sufficient to meet the needs of the population.

8. This is a System of enormous complexity and sophistication that cannot be stopped. Hence the importance of acknowledging the contribution of each of its actors, working jointly and avoiding a crisis with enormous impact on users.

9. The discussion cannot focus on the moles of the System, the complaints and the guardianships. Colombia today has one PQR for every 700 services and 1 guardianship for every 7,000 services, in a System that provides 2.5 million services per day. Each and every one of them is important and we work every day to attend to them promptly.

10. If we start from the advances, from the thousands of Colombians who are well served daily and from the undeniable achievements of the System, we can focus and concentrate on effectively improving those failures, which we recognize exist and which require everyone’s work.

The entity expressed through a statement that the union is ready to advance in a constructive conversation with the Government.

All this, as a result of what happened on July 27, when Sura, Sanitas and Compensar alerted the Government through a letter about the delicate financial situation in which they say they are immersed and that would put their operation at risk after September .

However, the minister dismissed their arguments and said that he sees no reason for these entities to stop operating in the coming months, after having held a meeting with them. In addition, he stated that if they go bankrupt, he would apply the figure of direct transfer to clinics and hospitals in an emergency to overcome the situation.