2023-07-06 06:10:53
12:01 AM
The saying goes that “nobody knows what they have until the day they lose it”. This is more or less the conclusion reached by an analysis carried out by the National Association of Financial Institutions (ANIF), which analyzed the possible impacts that the health reform would have on the provision of services, on the achievements made by the current system and even in poverty.
In the study – called “Possible impacts of the withering of the EPS within the framework of the health reform” – ten researchers participated and made an economic forecast with the reform underway: almost 750,000 people would enter monetary poverty and another 500,000 they would do it to the condition of indigence.
The explanation for this ANIF warning lies in a mathematical and verifiable fact since Law 100 of 1993 came into force: financial protection and low out-of-pocket spending for people who access health services. In other words, that people do not break down due to an illness, a medical emergency or a long-term treatment.
According to the data presented by the Association, before 1993 out-of-pocket spending stood at 40%, while in 2019 this indicator stood at 14.9%. Percentage that was more than four percentage points below the average for OECD countries (Organization for Economic Cooperation and Development) and almost 24 below the average for Latin America, where it is 38.6%.
This means that accessing the health system in Colombia – in addition to being easy, since coverage reaches 99.1% of the population – is cheap, compared to neighboring countries and the rich ones in the OECD.
However, for the researchers, the government’s health reform “intends to refound the health system, instead of improving what was built,” referring to the fact that changing and assigning new tasks to the EPS and the Administrator of the Resources of the General System of Social Security in Health (ADRES) translates into “putting the individual management of each patient at risk”. Ultimately, the main beneficiary of the system.
In this sense, the ANIF proposes that the reform will put an end to health insurance –which managed to have the level of universal coverage and have comprehensive risk management as its center–, since it will convert the system into one of delegated administration, similar to the scheme of recoveries.
“In an insurance scheme, the incentives to provide services in a sustainable manner are aligned, while an administration scheme breaks the logic of risk management and generates greater financial pressure for the State,” says the study.
How much is the out-of-pocket cost?
To give an idea of how much a citizen spends from his wallet when he requires some health care, there is the data from the Health Satellite Account of the National Administrative Department of Statistics (DANE), which indicates that by 2021 the expenses not covered by the health system health amounted to $3.48 trillion: $68,000 per person.
However, according to ANIF calculations, in the worst scenario with the implementation of the reform, the country could return to the levels prior to Law 100 and reach $10.2 trillion (about $199,600 per person).
All this cocktail of scenarios lies in the disappearance of the functions of the Health Promoting Entities, even if they continue as Health and Life Management Entities. “The possible elimination of the role of the EPS would have an impact on the flow of system resources, on the correct and efficient provision of services, and on the management of financial risks and health profiles,” they point out.
The concrete thing is that the health reform, which was approved in the first debate in Congress, -and which for President Gustavo Petro has meant political capital, governability and the stability of his own cabinet- what he has left over are warnings and objections about its impact on the public health of the country. And now this, which speaks of an economic impact on citizens.
Because if the health insurance and the experience of the EPSs managing financial risk are broken, it would trigger the model that guarantees this low spending on people’s health to fall like a house of cards and end up in that spending for the households rise and affect the most vulnerable and low-income people.
Without forgetting that, at this time and without a reform underway, the financing of the health system is at risk, as warned by unions such as Acemi and Gestarsalud, due to factors ranging from the increase in health care, payment per member and inflation and devaluation.
The resources that are missing in the EPS
According to Gestarsalud, the insufficiency of the allocations and transfers of the maximum budgets to cover the services that are not financed with the payment by each member is one of the aspects that affects the financial situation of the EPS. By May 2023, the estimated shortfall is approximately $1.03 trillion for all insurers. Likewise, $467 billion are pending recognition and transfer to various entities of the subsidized regime for the years 2020 to 2023. Meanwhile, the frequency of care in the subsidized regime increased by 30% between 2020 and 2022.
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