ANIF reiterates the call to attack the most pressing problem of the system, financing.
• Recent history shows that interventions in the EPS end in the liquidation of the insurers.
• The closure of EPS generates additional pressures, as the remaining insurers in the system are loaded.
• Increasing the number of members of an EPS suddenly implies longer waiting times for users. The case of Medimás shows that they increased by around 17.44%. Furthermore, the quality of care worsens because more must be done with the same human and physical resources.
• The EPS receiving affiliates of the liquidated entities are the ones that are now under the microscope of SuperSalud for their financial statements and quality indicators, which suggests a cascade effect in the system if a liquidation occurs.
• The displacement of the population to the acquisition of prepaid medicine plans, complementary plans or private medicine is a result of the detriment in service provision. This specifically affects lower-income users because they can hardly bear that monetary burden.
Concerns about the health system do not cease. The administrative interventions at two of the largest EPSs in the country and the voluntary liquidation of another of equal magnitude were situations that caused widespread anguish among users. Will these EPS be liquidated? What will happen to the affiliates? Will health services continue to be provided? These are some of the questions to which we will answer in this economic commentary, the second installment of our analysis of the situation in the health sector.
First of all, it is worth asking what it means for users when an EPS is intervened? In the short term, nothing. This, given that the Government initially seeks to organize and clarify the financial administration of the entities involved. However, as previous cases show, it is highly probable that the intervened EPS will end up in liquidation processes, as has been the case with Medimás and Coomeva, to mention a few. So far, of all the interventions that have been carried out since the establishment of the current health system, none have ended successfully.
Thus, in the event of a possible liquidation of the insurers, the consequences for the system are disastrous, which ends up directly affecting users. At first, there is a massive transfer of users, which imposes greater pressures on the system as a whole. To go no further, the closure of Medimás and Coomeva implied the transfer of more than 2.6 million members. Of them, more than 60% were received by EPSs that are currently in the process of intervention (Famisanar, Sanitas and Nueva EPS) and in voluntary liquidation (Compensar), a situation that puts the financial and administrative condition of the receiving EPSs in trouble.
Upon receiving the affiliates designated by SuperSalud, the EPS must continue the treatments and attend to current legal processes in the liquidated entities. Thus, the receiving EPS must ensure the provision of service, with the same physical and human capital as previous to the new affiliates. This generates delays in services, a decrease in the quality of care offered and puts users’ access and treatment at risk due to longer waiting times. For example, it was evident that after the Medimás intervention, the average waiting time for a general medicine appointment went from 1.72 to 2.02 days (which implies an increase of 17.44%); while global user satisfaction fell from 60.9% to 54.1%, from 2017 to 2021.
In this way, users seek to switch to other types of health coverage and services, such as prepaid medicine plans, complementary plans and even private medicine, which translates into an increase in out-of-pocket spending. This has harsh repercussions in terms of inequality in the system, where the most affected are low-income people.
To prevent reaching a more complicated state in the provision of health services, the Government must attack the problems of the system, which, as we have repeatedly mentioned, focus on financing. The timely payment of the maximum budgets of the UPC, as well as the review and updating of the latter by integrating elements that reflect epidemiological changes and increased frequencies of use, are vital to keep health afloat. These criteria are what have shaken the finances of the EPS, the reason why these entities have failed to comply with the Technical Reserve Investment Regime established in the law.
That is why from ANIF we call not to put at risk the right to health of Colombians and with this, one of the greatest achievements in terms of equity in the country. With the interventions and possible subsequent liquidations, there is the possibility that the remaining EPS become overloaded, leaving room for new interventions to the detriment of the provision of services to remain latent on the near horizon. With this, a domino effect that ends up undermining one of the best health systems in the world.