Dove Valencia
President Petro’s health reform will destroy a system that has taken us 40 years to work. The EPS are the heart of the system.
Law 100 created the Health Promotion Entities-EPS-. EPS are insurers that can be public, private or mixed. The State only gives each EPS a fixed value per year of 1.2 million pesos per Colombian, no matter how much the medicines and procedures are worth. This has made us have one of the best health systems in the world. We are the second country in the OECD with the lowest prices in the health system and we occupy the second position of citizens that use the least out-of-pocket health expenses. The system gives Colombians free access to 93.6% of the medicines listed in the country and 96.9% of the procedures. In the same way, the system has a reinsurance called “technical reserves” that today is equivalent to 8 trillion pesos.
The EPS have several fundamental functions: management and auditing, which with the reform would be adrift. The EPS guarantee access and are in charge of organizing the network to connect the member with the IPS-Clinics and hospitals-. They verify the IPS -high, medium or low complexity-, they monitor the treatments and have the clinical history of the patients. Health reform destroys this to move us all to a state system. The EPS are over.
The simplistic idea of Minister Corcho is that the resources of all health, of all Colombians, be managed by the State through ADRES. An entity that would be a payer and would have levels in the municipalities and departments.
If the reform passes, Colombians would have to go to primary care centers to “join” and hope that from there they will give them appointments, medicines, and redirect them to more complex centers.
The EPS carry out long-term negotiations to establish the prices of all services (exams, consultations, medications, etc.). Incentives help to find the best cost-quality procedures for patients. It has taken EPS 30 years to learn how to negotiate and set fluctuating prices in the market. Experience that is lost with the reform. Cork’s solution is bad. I would replace this negotiation with a rate manual. That is, they would pay the same to a good hospital as to a bad one, which would lead to a drop in quality.
In addition, the EPS audit the invoices of the IPS and make the corresponding payments. This prevents over-billing, verifies that the service has been provided and, above all, evaluates that the procedure is what the patient requires. What prevents the money from being stolen, as some of the SOAT money is stolen.
With the reform, the system would be left without an independent insurer or auditor. Now it will be the State that will directly transfer the resources to Hospitals and Clinics through the ADRES entity. It will be divided regionally and will be administered by a Council where the mayors and governors will be. They are going to give the health money to politicians. This added to the fact that the Government will deliver 80% of the resources without verifying the authenticity of the invoices. Today the territorial health secretariats have not been able to verify even 3% of the invoices in 2018 and 2019.
Without an auditor, doctors will have self-regulatory boards so that they themselves can determine whether they are prescribing too much or too little.
The government will also give priority to medicines produced in the country, even if they are of lower quality and more expensive than abroad. Petro’s nationalized health system will be a black hole of resources.
We cannot control corruption in ESCOs and public hospitals, and now we will expand its field of action over the resources of the entire system. Not only is it risky, but it also leaves out the enormous problem of inefficiency that the State has. But the bureaucratic party promises support in Congress: they will create 5,167 new government entities with the reform.
Colombians will not have free choice over clinics and hospitals; nor will they be able to choose between private or public providers. We are all left in the public, with its corruption, its inefficiency and its high cost. The mere construction and organization of Primary Care Centers will be worth 25 billion pesos to the State. How much will the other 5,000 entities cost?