A package of norms comes in the 180 pages of the text of the health reform that was filed this Monday by the national Government, in which 152 articles are consigned that will be reviewed with a magnifying glass in the Congress of the Republic. Meanwhile, it should be noted that the text brings a proposal that aims to practically end the moderator fees and co-payments, which are charges that the EPS make to users of the health system each time they access a service.
Whether it is a medical appointment, the practice of an exam or the delivery of a medication, the contributor must contribute a moderating fee, which varies according to the citizen’s income: the amount is established according to the minimum wages earned by the contributor.
It must be remembered that the moderator fees were established in order to control overuse of the service, but citizens complained that many could not access care because they did not have the money.
The copayment, meanwhile, is a monetary contribution that corresponds to a part of the value of the service demanded by a user. In this case, the purpose is to help finance the system.
In both cases, there are established rules, depending on whether they are affiliates and beneficiaries of the Contributive or Subsidized Regime (in the latter case, it applies to affiliates classified at level 2 of the Sisbén or higher).
The truth is that the Health Reform project filed this Monday establishes that these charges “They will cease to be economic barriers to access the benefits of the Health System.”
In the same way, the proposal emphasizes that conditions such as pre-existing conditions or requiring minimum contribution or grace periods cannot be established either. This implies, from the perspective of the proposal, that these barriers would also be removed. However, the EPS union drew attention to that particular point, in the comments it made to this medium.
How much income does the moderator fees and copayments involve?
The moderator fees and copayments in the health system are adjusted annually. Thus, for 2023, it was established that, in what has to do with the contributory regime, in the case of the moderating fee, the current charges are defined according to the rank of the affiliate.
This is how, for rank A, which corresponds to people with incomes of less than two minimum wages, the payment is 4,100 pesos. If the affiliate or his beneficiary belongs to rank B, which implies that he earns between 2 and 5 minimum wages, they have a quota of 16,400 pesos.
Finally, rank C, which applies to people with incomes greater than five minimum wages, the moderator fee that must be paid each time you use a service is 43,000 this year.
On the side of copayments, The maximum collection limits were also established in 2023. The values depend on the same three ranges in which citizens were placed in the health system, according to their income.
Thus, for range A, the limits go from 304,583 to 610,227; for B, the values that apply range between 1,220,455 and 2,440,909 pesos. In the case of range C, the charges established for copayments range between 2,440,909 and 4,881,818 pesos.
Bearing in mind that in Colombia there is health coverage close to 99%, of which 49% of 50.8 million inhabitants are in the contributory regime, and 47% are in the subsidized, counting on the fact that there is a 4% that is part of the so-called exception regime, it could be thought that there is a lot of money that the EPS would stop receiving due to the non-collection of moderating fees and co-payments.
Even if the article of the Health Reform that refers to the subject, speaks of an exception, in which the charge would be applied: “The use of hospital and specialized treatments not ordered by the Health Centers is excepted from this norm. Comprehensive and Resolute Primary Care in Health and not originated in a vital emergency, in which case the co-payments regulated by the Ministry of Health may be charged. The continuity of the treatments originated in a vital emergency must be authorized by the respective primary care center, which will verify if the institution is the ideal one to care for the patient. and, if not, it will refer it to an appropriate institution according to the network of which it is a part. This notification will be given within the first two business days so that the service can be recognized by the regional Funds and not give rise to co-payments,” the document says.
What does the EPS union say?
For the EPS, stop charging, due to restriction in the collection of moderator fees and coopagos implies ceasing to receive resources equivalent to 2% in the Contributive Regime, and less than 0.5% in the Subsidized Regime, according to information provided by Acemi, EPS union.
In addition, according to what Acemi stated, there are no access barriers for care in this sense: “today the Court has said that they cannot be (moderating fees and co-payments) access barriers: which means that if the person says that they cannot pay the EPS, they cannot deny them care”.
Another of the comments that Acemi shared refers to the application of pre-existingaround which he said: “In the public system today there are no pre-existing. The EPS have the obligation to attend to all the health services, whether they are of low or very high complexity, from the first minute of the affiliation or in case of transfer from one EPS to another”.