Specify and clarify debts between different actors in the health system, asks the Petro Government for comptroller.
The Comptroller General of the Republic, Carlos Hernán Rodríguez Becerra, called the National Government’s attention to the need to clearly specify the real cost of the Health Reform, in order to guarantee its implementation, as well as its sustainability in the medium and long term.
In this sense, the head of the control body warned about the need to purify and clarify the debts between the different actors in the system, as a prerequisite for the implementation of the new financing and resource flow mechanisms, with an effective reorganization process. , in the transition times from one model to another.
“This Comptroller’s Office makes an urgent call to the national Government to report to us the cost structure and the previous studies on which it has been based for the projection of the same, taking into account the need and the concern that assists us to carry out what is within our competence, in the follow-up and vigilance due to public resources, in order to guarantee the fundamental right to health of the population”, he expressed when installing the Forum “Protection of the Right to Health from Control Prosecutor”, event held within the framework of the celebration of 100 years of existence of the Office of the Comptroller General of the Republic.
For the Comptroller, a critical aspect evidenced in the current health model refers to the debts of the EPS with the providers that, according to what was announced by the Superintendence of Health, would be in the order of $23.3 billion, and according to The analyzes carried out by the CGR with information from the most recent report of Circular 030, with a cut-off of September 2022, could amount to $26.1 billion.
More effective control measures are needed
The controller warned that the debts with the providers, in charge of the EPS that are under special measures, run the risk of not being canceledsince what is normally observed is that the entities that enter into these measures end up in liquidation processes, with the risk of loss of the resources committed in these portfolios, since the assets are insufficient to cover their receivables.
In the exercise of monitoring compliance with Judgment T-760, the CGR reported, as of December 2022, a total of $6,527 million corresponding to health audits, $28,821 million of special inspection actions, $224,248 million of preliminary inquiries; in addition to 524 fiscal responsibility processes for a value of $1.3 trillion and 102 coercive jurisdiction processes for $1.6 trillion.
From the above, it can be noted that the materialization of the financial risk of the IPS is evident, to the extent that the timely and sufficient flow of resources is not guaranteed, for the provision of the health service, which, finally, affects the quality of care for affiliates.
Adres processes require adjustments
Comptroller Rodríguez Becerra expressed “great concern” about the risk of loss of system resources if the pertinent adjustments to the Adres processes are not carried out, according to what the CGR has been able to verify in various actions it has carried out. about this entity, which with the Health Reform would centralize the direct management of the sector’s resources.
He mentioned three aspects of the Adres that are of particular concern to the Comptroller’s Office:
1st. The weaknesses detected in the Adres by the CGR, in terms of monitoring system resources, as well as the audit processes of non-SOAT medical accounts and recoveries by the EPS, which have determined transfers or payments to various entities without due rigor, without verification of compliance with critical requirements to make the corresponding payments for health services charged or recovered from the Adres, in which the weakness in terms of non-SOAT medical audit and recoveries has been notorious.
2nd. In second place, the outsourcing of the audit of accounts of its competitionwhich implies the need to evaluate the cost-benefit of said outsourcing, which has also generated inconveniences or disruptions to the flow of resources, such as the 080 contract process, whose incident meant two years of delay in the audit for the payment of the recovery accounts to the EPS, for services provided during the 2018 and 2019 periods, the greatest impact of which was suffered by health service providers at the national level, and which gave rise to the Final Point Agreement.
Third and third, regarding the institutional capabilities and competencies of the Adres, the CGR evidenced weaknesses and risks in the audit exercises, related to the lack of human talent to carry out audits and the lack of information to initiate the processes of recovery of the collection by concept of claims. Likewise, the need to be strengthened in its interoperable information systems, which guarantee transparency in the use and flow of resources; with a visible transactional system, which has cybersecurity tools to also guarantee the security of financial and health data.
“The question arises for this Comptroller’s Office about how the processes of auditing and monitoring the transfer of system resources will be, by the Adres, from now on, given the new panorama of implicit risk in the reform, which must be weighed. , evaluated and mitigated to the maximum, to avoid the possible loss of resources in the sector, since this administrator, in addition to their management, intends to be in charge of the contracting processes for health services”, noted the Comptroller.
“I must add with the greatest emphasis that this Comptroller’s Office, based on the proposed reform, will adapt and direct its focus of attention mainly towards the Addresses and its internal processes of management, use, destination and flow of resources, without neglecting the other actors of the System, through the different tools that we have, in order to prevent, mitigate as much as possible and avoid possible losses of system resources or detriment to the public patrimony”, he warned.