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There is a desperate search for regressive health care reform: Ruiz

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One of the star ministers of the previous government, without a doubt, was Fernando Ruiz, who for many faced the crisis caused by the pandemic with great capacity. Today he has become one of the main opponents of the health reform, whose text has already been known.

Ruiz considers that this initiative will lead to centralization and a very dangerous control by the State over health resources. In the same way, he thinks that there is a desperate search to carry out a regressive reform, very ideological, where the most affected will be the poor, and the long lines will return to obtain a token and obtain a medical appointment.

The former Minister of Health spoke with EL NUEVO SIGLO about his concerns.

THE NEW CENTURY: Have you had time to review the draft of the health reform? What are your observations?

FERNANDO RUIZ: Contrary to what the Minister of Health proposes in many statements, what this really implies is the replacement of the health system by a completely new one, a system of conditions where the provision of services is radically changed and where it is seen a clear tendency to transform the system into a public one, with a dominance over the rest of the health service networks and where the restrictions currently exist, given that in Colombia there are only 1,200 public hospitals compared to about 11,000 private centers, They will cause great difficulties.

The regime proposes the construction of a new infrastructure and it is not seen how the structure of health centers and processes adapts to the claims that exist in the model of services and benefits that is proposed for Primary Care, since that practically implies the construction of nearly 2,500 new primary care centers throughout the country. This means a very large investment, but additionally a process that will not be immediate but will surely last 10 years and will imply a very severe problem in the transition from the current system.

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There is a huge gap in the proposed reform of what this transitional process will be like, which will not be in the short term. What will be done with patients with chronic diseases? How will the portability of the service be guaranteed? How is the sustainability of private hospitals and clinics in Colombia going to be maintained and guaranteed? Currently, they are highly dependent on the flow of resources, the majority of which is destined primarily for hospital care.

ENS: What will be the future of the EPS under this new model?

FR: The minister says that the EPS are not going to disappear, but when one looks at the texts of the reform there is no place for these structures. So I see that this corresponds more to a strategy to reduce concern and pressure from citizens about the need for insurance. But this is going to be a model, basically provisional, where the service structure is going to be fundamentally public, with some elements of derivation to the private sector, but where in essence what is going to have are models of service provision, not a insurance model, and that is a very big cause for concern.

There is nowhere the explanation or specification of how this assurance would be assumed, who would be responsible. In some statements it is implied that it would be the State itself, but even though it is the Government, if that is the model, what we are facing is a system that is transformed into a Social Security plan where the Executive assumes absolutely everything and where Clearly, the restrictions that are going to be in the budget will determine very large limitations in access to services.

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ENS: Do you think that those most affected by this reform may be low-income people?

FR: In the end, people who have resources can pay for an insurance policy, they will do so without any problem. An insurance plan for a person over 65, the highest risk, is worth at least 14 million pesos a year, 1,200,000 a month. Those who have the capacity to pay this money are from the upper middle class and the upper classes, but the most affected will be the poor. We are going to see lines again to obtain a file and obtain a medical appointment and surely queues to have access to laboratories and diagnostic tests and what is called in other places waiting lists for surgeries and other procedures. A large part of the Colombian population are middle-class and low-income people who will be affected.

ENS: Do you see it as appropriate for health resources to be managed by the State?

FR: What there will be is a centralization of resources, a very dangerous control by the State over health resources, and this could lead to a space for bureaucratization, but above all to problems of corruption due to the regional management of these resources. . This is going to be a very complicated problem when regional and departmental politicians seek, as they have done within the organization of the State, how to manage things that will be very complicated, and it is not clear where the ability to control said situation is.

ENS: Do you feel worried about the future of the health system?

FR: There is a desperate search to carry out a regressive reform, to carry out a very ideologized reform, and in this desperate search a number of inaccuracies have been committed that confuse and greatly reduce the moral and ethical authority of the Ministry in what has to do with the responsibility towards Colombians. I am very worried. I believe that a scheme that has proven to be equitable is being changed here, which has allowed more than 80% of Colombians who were not in an insurance scheme to enter a social security program and replace it with a public scheme in which in which there will be no guarantee and in which freedom of choice will not even be respected. Before 1993, only 23% of Colombians had social security, today it is 100%. That is what is going to be lost in this process. This will represent a setback that we had already surpassed a system of the social security type and a missionary type of health service, where only charity services are provided and where the health service is going to be seriously violated.

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ENS: What would be your recommendation to improve the current care in the EPS?

FR: I think care needs to be improved in rural areas. You have to leave a rational number of EPS; I believe that in Colombia there should only be between 12 to 15 very solid EPS, very structured. Work has been done on this process in recent years, which was surely going to improve several aspects of care, but not like this one that is being considered with such a severe loss of well-being.

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