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Health reform without fiscal guarantee

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Health reform without fiscal guarantee

The Ministry of Finance did not issue fiscal endorsement for the health reform. It issued a “feasibility scenario,” and also with wrong assumptions, it concluded that the reform would cost 140 billion pesos in 10 years.

The government intends to create 2,500 Primary Care Centers-CAP. According to the Treasury, the CAPs would have a cost of 8 billion, however, they assume that they will be able to continue using 16 thousand first-level hospitals that the country already has.

What will be the cost of hiring those hospitals? Or how much will it cost to buy them?

It is not yet clear whether CAPs are top-level hospitals requiring about 100 employees each, and whether they are just a care center with 15 employees.

The payrolls would have 250 thousand or 37 thousand employees, and in this optimal case the rest would be in first-level hospitals.

The Treasury assumes that primary health care will cost about 7 billion pesos per year. However, they do not take into account the cost of the 20 thousand Basic Health Equipment that the president promised throughout the country.

Each CAP would also have about 10 Basic Health Teams, made up of more than 10 professionals (doctor, auxiliary nurses). That list of 200 thousand people would walk to the house of each Colombian checking basic health and giving recommendations. According to our calculations this would cost about 16 billion pesos per year.

Colombia has few doctors and very few nurses. The visitors would use more than 20% of the country’s current medical personnel. Who will attend the hospitals?

In its document, the Treasury confirms that they are going to liquidate several EPS and that the government will capitalize the New EPS – State EPS – so that it can receive all those affiliates.

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According to the government, capitalization will cost 2.5 billion pesos. How many EPS will be liquidated? How many users can the New EPS receive with 2.5 billion pesos? How much would it cost you to receive the 50 million Colombians if all the EPS disappear? What is the cost increase per year?

The EPS disappear and managers are born, the true health intermediaries. With very basic functions they will begin to earn more than they earn today.

The Treasury speaks of 2 billion a year. However, our calculations are more than 3 billion. Furthermore, the Ministry accepts that the reform does not assign who will assume the financial risk in health, currently in charge of the EPS, and they propose to the government that the ADRES assume it.

The Treasury claims that it does not have the capacity to estimate how much the country’s new health information system that they intend to introduce as a control mechanism will be worth.

They cannot calculate the information backbone of the reform, because they do not yet even know what it is like.

They assume that the UPC – the value available for the health of each Colombian – will be spent by 95%. Today studies reveal that it is insufficient. Between 102% and 108% of it is being spent.

The Treasury would have a gap in its calculation per year in this area between 1.1 billion and 4.6 billion pesos.

The government affirms that health technologies will grow over the next 10 years with general inflation, when it has been proven that health inflation is much higher than general inflation.

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They affirm that employment, health contributions and State income for the health sector will grow 8% on average in the next 5 years, when the country could be entering a serious economic slowdown.

The document is not signed by the minister, but by the vice minister and closes without making the project viable. At the press conference the minister chose to give a balance of what the health system would cost with and without reform, to show lower apparent costs.

They assume that the reform will save many lives and that preventive health prevents disease, and that is why the system will be cheaper in the future.

It seems that they do not see that old age alone, thus prevented, requires more health, and the Colombian demographic will continue to age.

A bad reform is a risk to everyone’s health. A health crisis could even destabilize institutions. Congress must sink this bad, very bad reform.

The treasury document that was not a fiscal endorsement but rather scenarios, which contains a balance table shown at the press conference, and another real table of costs in the document, which is not signed by the minister but by the vice minister, and which recommends changes to the reform from the government itself, demonstrates the pressure that treasury officials have felt to show something positive about the reform.


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