By Ramiro Antonio Navia
The health reform proposed by President Petro is being debated in the Congress of the Republic. Through networks and the media, the parties express their opinion and defend their positions on the issue; It is important to remember that the current system has been in force since December 23, 1993, thirty years ago, when Law 100 came into effect.
Comparing the main aspects of this Law, compared to what social security in health was before it, we will better understand the scope of the reform led until recently by former Minister Carolina Corcho.
Starting with coverage. Before 1993, the social security system in health covered only 22% of Colombians, only those who were dependent workers had access, of these, those in the public sector, depending on the origin of their entity, were affiliated with the National Provident Fund , departmental or municipal health funds, and private sector workers to the Social Security Institute. It was a completely state system, the remaining 78% of Colombians had two options, those with economic capacity assumed health care out of pocket and the rest, which was the vast majority, went to public hospitals to be treated in services that were called charity.
With the current system, coverage reaches figures higher than 95% of nationals who are affiliated with public and private Health Promotion Companies, freely chosen by each person and in the same way they are treated in public and private hospitals. Regarding comprehensiveness, understood as the coverage of all contingencies that affect a person’s health, the previous system only offered workers an almost comprehensive plan and wives only maternity care, so the other contingencies for them and their children had to care at the expense of the worker or resort to the aforementioned charity services. The current system offers workers, their wives and children an almost comprehensive health plan, both in the subsidized regime and, even more so, in the contributory regime, and there are fewer and fewer exclusions.
Let us now highlight the main aspects raised in the health reform proposal established a few days ago at the congress: A preventive, predictive and resolute health model served in comprehensive and integrated health networks and with an emphasis on primary care. These concepts exist and have been applied for many years, but they must be improved by strengthening health promotion and prevention, as well as the resolution capacity of low complexity, it is necessary to invest in physical infrastructure and resources to achieve greater resolution at the first level of care. .
Taking services to remote areas is not a new concept either, the Statutory Law of 2015 established the creation of health policies for remote areas, you just have to comply with the Law. Universal coverage is not a new objective, in fact, the Law 100 had set the year 2,000 as the term to achieve it and as mentioned, only today that objective is about to be achieved, but it is also true that in many cases this right does not translate into accessibility and attention, mainly in EPS that attend the regime subsidized, therefore, the substantive improvement sought in the bill is absolutely necessary. Labor dignity of health workers, formalization is an imperative
need, costs a lot of money and should certainly be included in the Labor reform.
Drug price control is not a new idea, the Statutory Law of 2015
had elevated price control in the country to public policy, this is important for the
financial viability of the system, the Law must be complied with. As we can see, it is not
No new concept can be highlighted in this reform proposal, not even the
its true objective, which is total nationalization with the disappearance of the EPS,
because we already lived that model for decades before 1993.
So, really, a reform would not be necessary, just complying and enforcing
current regulations and strengthening some aspects, such as health prevention,
care in remote areas, investment in hospital infrastructure and formalization
employment, almost all desired objectives would be achieved, to benefit all people,
but what is really at stake is the nationalization of the system and, therefore, the handling of 70
trillions of pesos annually; Hopefully both the Government and Congress think less about
these and more in the Colombian people who will ultimately be the ones to suffer any decision
wrong.
The costs of the reform and the continuity of the EPS, companies that are not so bad or
unnecessary as some claim, but not as good and holy as they claim
others, that some comply, but others bury hospitals, which at the moment have
large debts with them and that impose tariffs on State Social Enterprises
first level public, are issues that deserve another space.