The Domino Effect: The Impending Collapse of Colombia’s Health System

2024-02-25 02:00:00

Cambio magazine recalled last week that President Petro said some time ago: “if I wanted to finish the EPS, I would not present the project. I let what’s happening happen and shu-shu-shu, that’s a domino (…). It is nothing but waiting.”

The shu-shu-shu has arrived: the dominoes are falling.

The Comptroller General’s Office and the prestigious Sector consulting firm show that the health system has already entered its terminal phase and is close to definitive collapse. In particular, Sectorial predicts that the end will follow three phases:

January-July 2024: Use and depletion of EPS technical reserves. The Comptroller’s Office points out that the situation is dramatic, since the EPS have debts with suppliers, IPS and lack of reserves for $25 billion. Only two large EPSs, Sura and Salud Total, do not have reserve defects. The accumulated debts, which the government has not recognized and which amount to $10 billion, added to this year’s definancing of $3 billion, have caused this situation. This problem will only get worse as the months go by and this will precipitate the entry into the next phase.

August-December 2024: Consolidation of a state monopoly in the hands of Adres and Nueva EPS. This will be the consequence of the intervention and liquidation of the majority of the EPS, as a result of the financial drought caused by the Government. But the public monopoly that, according to the authorities’ strategy, will concentrate the majority of the country’s patients, is financially and administratively vulnerable. The Comptroller’s Office points out that the New EPS also seriously fails to comply with the technical reserves by $5.5 trillion and owes $900,000 million to the IPS. On the other hand, the new administration of this entity is characterized by its lack of technical capacity and carries terrible experiences in health management. At the end of this phase, the main purpose of the Government reform will have been achieved, that is, de facto eliminate the EPS, nationalize health and manage, outside of public contracting regulations, just over $90 billion a year.

2025-2026: System collapse. As a consequence of the growing liabilities with the IPS (90% of the 12,000 IPS are private) and the Government’s revealed preference for public entities, patient care will decline and the system, as we know it today, will collapse.

Given the announced death of the EPS, it is evident that what Congress does with the reform project that is entering its third debate in the Senate will have little or nothing to do with the future of health in Colombia. If, on the spur of the moment, the law is approved, it will fall due to unconstitutionality. But, above all, when the debates are over and the legal examinations are over, the current system will no longer exist and a public monopoly will have been imposed. Colombians will once again suffer the consequences of a regime similar to the one they suffered with Social Security and public hospitals.

The cost of shu-shu-shu will fall on the well-being and lives of millions of Colombians who today receive care, quite good in international comparisons, who will be exposed to a lack of appointments, procedures, medicines and care, in the hands of an underfunded system. and managed with political criteria.

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