"Health Reform: Understanding the Transformation of EPS to Health and Life Managers"

2023-04-22 19:32:32

This Tuesday, April 25, the debates will begin in Congress on the Health Reform, which will be discussed on the basis of a final text that allowed the project to continue forward. According to the letter, of 156 articles contained in the paper filed, about 60 were modified, that is, approximately 40% of the project.

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One of the concepts introduced by the reform introduced by the Government was the creation of Primary Care Centers (CAPS) and the consequent elimination of Health Promotion Entities (EPS). At the time, there was talk of territorializing these entities that would concentrate their operations in the cities and departments with the largest number of affiliates during a process described as a “transition stage” while the CAPS infrastructure was developed.

However, the debate over the elimination of the EPS seems to have settled with the final text of the articles that propose their transformation (and not elimination) to “Health and Life Managers”, a figure also criticized by the sector because it did not seem The function of these entities as “managers” within the system must be clear.

However, the final text clearly specifies what the transformation process would be like, ensuring that those EPS that are currently operating in the General Social Security Health System will continue to do so for up to two (2) years as long as they meet the permanence conditions established applies to them (financial sustainability).

Likewise, the document makes it clear that the transformation of the EPS does not imply its liquidation but rather a dissolution process. “The assets, liabilities, patrimony, will pass en bloc to the Health and Life Management Entity with subrogation of all duties,
rights and obligations, in the terms in which the National Government regulates it” assures the letter that emphasizes that the transition of the affiliates in charge of the EPS that are transformed, to the rules of social health insurance will also be determined by the National Government .

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In this sense, the EPS want to become Health Managers, must meet the following conditions:

1. Collaborate in the organization of the Primary Health Care Centers in accordance with the organization of comprehensive and integrated networks of health services by the Ministry of Health and Social Protection that will be financed by ADRES.

2. They will be subject to direct transfer by the ADRES to the provision institutions
of public, private and mixed health services, providers of technologies in
health or pharmaceuticals and other services required to guarantee the provision
of health services to the assigned population.

3. They will be progressively organized by territory according to the health planning and evaluation carried out by the competent bodies.

4. They will articulate the health service providers within the comprehensive and integrated networks of health services organized and authorized by the Ministry of Health and Social Protection.

5. All Health Promotion Entities (EPS) that state in writing their intention to become Health and Life Management Entities (EGVIS) must be in good standing with creditors regarding non-current debts within the framework of regulations that governs them, at the time of the manifestation.

6. No later than two years, the Health Promotion Entities that meet the requirements may become Health and Life Management Entities (EGSVI), which may be private or mixed and their formation, qualification and operation will be in accordance with the conditions and terms indicated in this Law.

7. All Health Promotion Entities will have a maximum term of two (2) years to comply with the provision prohibiting vertical integration in medium and high complexity.

8. The EPS that remain in the transition period will receive the annual per capita value without a situation of funds, for medium and high complexity services, which will be recognized monthly in accordance with the definitions of the Ministry of Health and Social Protection, taking into account into account the recommendations of the National Council
of health.

What will their functions be?

According to the final text, the specific function of Health Managers will be to contribute to comprehensive risk management in the health territory assigned to them, for which they must fulfill the following functions:

1. Coordinate with Departmental and District directorates the support required by the Ministry of Health and Social Protection in the organization of Comprehensive and Integrated Networks of Health Services for the Health Territories.

2. Contribute to the strategic planning of the development of the Comprehensive and Integrated Network of Health Services, under the coordination of the Territorial Entity and the Ministry of Health and Social Protection.

3. Implement effective mechanisms for Care Coordination within the Comprehensive and Integrated Networks of Health Services, which contribute to the continuity
of people’s attention.

4. Execute, under the direction of the Territorial Entities and ADRES, the activities of
monitoring and evaluation of network performance in the complementary component.

5. Implement situational rooms that allow the analysis of information, through management boards for decision making, alert reporting and delivery of
inputs for the exercise of the functions of Inspection, Surveillance and Control of the
National Superintendency of Health and Territorial Entities.

6. Deliver periodic reports on the operation of the complementary component
of the networks and attend to the instructions and recommendations given by the governance instance of the Network.

7. Participate in the Advisory Council for Planning and Evaluation of Comprehensive and Integrated Networks of Health Services.

8. To the efficient, rational and optimal use of the financial resources available in the complementary component of the Comprehensive and Integrated Network of Health Services.

9. Manage training plans to strengthen the operation of the complementary component of the Comprehensive and Integrated Network of Health Services under the strategy of Primary Health Care.

10. Provide technical assistance to the members of the network for continuous improvement, the implementation of innovative models of health services and the strengthening of the quality of health care.

11. Manage, in coordination with the CAPS, access to the complementary component
of the RIISS through the referral and counter-referral system and with support
of the Unified Public Health Information System.

12. Manage in coordination with the Territorial Health Directorates, their Centers
Regulators of Urgencies and Emergencies and Primary Health Care Centers
CAPS, the provision of specialized services for people with illnesses
rare diseases and their prevention according to the guidelines of the Ministry of Health and Social Protection.

(You may be interested: Reform established ends the EPS and puts the health of the country at risk: Gestarsalud)

13. Guarantee timely and expedited access to health services and pharmaceutical services to people who require them in such a way that their provision does not affect the opportunity, relevance, safety and efficiency.

14. Implement technological tools to interoperate with security systems.
information from the RIISS and with the Single Public Health Information System, in the
manner and conditions determined by the Ministry of Health and Social Protection.

15. Carry out the quality audit, of medical accounts and concurrent of the provision of health services of the complementary component of the RIISS.

16. Validate the invoicing of the complementary component of the RIISS, which will be sent to the ADRES for the payments that may take place.

17. Implement a System of Information and Attention to the Population through which they interact with people, associations of users or patients and others
civil society organizations, in order to know their concerns, requests,
suggestions, complaints and denunciations, in order to provide effective solutions to the
manifest compliance.

18. Carry out accountability of its activities with the periodicity, mechanisms and
on the issues established by the Ministry of Health and Social Protection.

19. Carry out the management for the payment of economic benefits.

It should be noted that, according to the document, Health and Life Management Entities will be recognized up to 5% of the per capita value of the population attached to the Primary Care Centers (CAPS) to which the Manager guarantees care in the medium and high complexity.