The health reform added two proposals with the arrival of the second legislature, with the texts filed by Cambio Radical and the Liberal party. From the previous period, the Government’s project is in transit, which managed to advance in the midst of the controversy over the adjustments it makes to the system and which is up for a second debate in the Chamber plenary. The initiatives have key differences. Below are the main ones.
To begin with, it must be remembered that the controversy continues over whether the reform should be carried out via ordinary law, as presented by the Government, or statutory as established by Cambio Radical and the Liberal party.
The Government reaffirms that its reform is an ordinary law. “Law 100 is an ordinary law and what we have presented is a reform to Law 100. The statutory health law already exists and we do not want to reform it,” said President Petro.
However, an appreciable number of congressmen who are not part of the ruling party maintain that the Government is wrong, since it should have presented the reform as a statutory law because the provisions contained in the project comprehensively regulate the content and scope of the fundamental right to health.
The first big difference in the three projects is that the Government seeks a fundamental reform to transform the General Health Security System, based on social insurance to guarantee the fundamental right.
Cambio Radical believes that changes must be made to improve the system and the service, based on “recognition of the successes achieved and lessons learned in these almost three decades.”
While the liberal project points out “that any reform to the health system must take special consideration of social progress in closing inequality gaps.”
Las EPS
One of the most controversial points of the project presented by the Government is that it eliminates the role that the EPS have played for three decades in insurance of health and financial risks, as well as articulation of the system, which for unions like Acemi can cause a mess.
As a consequence, the EPS must be transformed within two years into health and life managers. Among the functions they will have, they must develop in coordination with the Primary Health Care Centers (CAPS) actions to identify health risks for the population in charge in the territory. They will be progressively organized by territories for health management. They will also articulate the service providers.
The Radical Change project maintains the functions that the EPS have. What is new is that they will operate through health territories defined by the Government.
While the Liberal party in its proposal also maintains the EPS as they operate today, only it gives the State a leading role in the governance of the system, coordinating these companies so that they do their job well.
However, the project contemplates that in remote regions in which the fundamentals of the health system market do not work, the State can directly operate the insurance, complying with the same technical standards of the EPS.
resource flow
The Government project establishes the direct line of business to pay hospitals and IPS for the services provided, delegating this task to the Adres (Administrator of the Resources of the General System of Social Security in Health), which will manage the system’s money and will be the sole payer.
Currently, the EPS are the ones that manage the resources they receive to pay the service providers, money that comes from the monthly contribution made by the members (in the contributory regime), the transfer made by the Adres (in the subsidized regime) and a premium that the State, the UPC (Capitation Payment Unit) gives them.
However, this proposal has been criticized by some political sectors and unions such as Acemi, which groups the EPS, since they say that the ADRES does not have the capacity to be the sole payer of the system or the expertise that these companies have developed in more than three decades that they have been doing this task.
The Radical Change project establishes that the Adres will be the entity that on behalf of the health insurers (the EPS) will transfer 90% of the UPC resources destined for the payment of services.
While the Liberal party foresees that the Adres will be in charge of making the transfer of resources for the provision of services and the technologies contracted by the EPS.
primary care
The three health reform projects that are up to now to be discussed in the second legislature coincide in strengthening primary care.
The Government project says that the preventive, predictive and resolute health model is based on primary care focused on people, families and communities.
In this project, the cornerstone of primary health care are the CAPS, which are the multifunctional unit of a public, private or mixed nature, territorially based. They will develop the processes of population affiliation, administration and attention to the citizen, provision of health services, among others.
The project of the liberals also contemplates the figure of the CAPS. However, unlike the Casa de Nariño proposal, they must be highly decisive and, in remote areas, they can receive supply subsidies, but conditioned on good performance.
This reform proposal points out that “the health care model must define specific mechanisms, interventions and actions adopting the primary health care strategy, which implies the development of a highly resolving primary component within the Comprehensive and Integrated Health Care Networks (RIIS)”.
For its part, Cambio Radical proposes consolidating a primary care model with a territorial, family and community approach, for the prevention, promotion and maintenance of health; near the place of residence, work or recreation; by a primary provider of free choice.
In the latter, there is a difference with the view of the Executive of the CAPS, since in the government model there is no free choice of the citizen, because he is attached to the attention center that exists in the territory where he lives.
UPC
The Government’s reform project indicates in this regard that the Ministry of Health, taking into account the recommendations of the Advisory Commission on Benefits, Costs, Rates and Operating Conditions of Health Insurance and the National Health Council, will define the annual value of the UPC.
Cambio Radical proposes that the Ministries of Health and Finance will define the annual value of the UPC, which will have a fixed and a variable component.
While the project of the liberals states that the ministries of Health and Finance will define the annual value of the UPC, calculated based on the population and epidemiological composition of each EPS for each member of the system.
Human talent
The government’s reform initiative establishes that, within the framework of the provisions of Law 1751, the policy must include general criteria to improve fair and decent working conditions for staff, with stability and facilities, and also to increase their knowledge.
While Cambio Radical rejects labor outsourcing for human talent in health, and instead the staff must be integrated under contract with all the requirements.
It also commits the Government to have an interoperable human talent information system.
In turn, the Liberal party proposes the training of more human talent, but also to improve the quality. On the other hand, the labor dignity of health personnel, establishing working conditions in accordance with their high social and strategic value.
Likewise, the project orders the Government to implement the national policy of human talent in health.
Transition
The Government project does not contemplate a transition period to adapt the system to the reform. Only in the case of the EPS, it gives them two years to adopt the figure of health and life managers.
Radical Change establishes that after the entry into force of the law, the Government and the other actors will have up to three years of transition to implement the care model.
While the project of the Liberal party does not have a transition period.