This March 12, a group of seven senators from the Seventh Commission presented a negative report on the government health reform. The document compiles several reasons for rejecting the initiative, highlighting the setback in terms of acquired rights, limiting users’ freedom of choice regarding health service providers, without clearly establishing patient care or the delivery of medications. This, they argue, endangers the health and lives of millions of Colombians, especially those who require continuous care for high-cost diseases.
The group is made up of Lorena Ríos Cuellar (Colombia Justa Libres), Honorio Henríquez and Alirio Barrera (Democratic Center), Nadia Blel Scaff and José Alfredo Marín (Conservative Party) and Miguel Ángel Pinto (Liberal Party) and Berenice Bedoya (ASI Party) .
In addition, the senators criticized the reform for lacking fiscal support and showing financial unsustainability, pointing out the lack of a positive concept on the part of the Ministry of Finance and the absence of clarity in the quantification of costs and sources of financing. They also highlighted that the reform ignores the achievements of the current health system, introducing uncertainty about user care, payment for disabilities and licenses, and omitting the regulation of the occupational medicine procedure, which could increase health spending for households. Colombians and raise poverty rates.
Finally, they pointed out that the health reform proposal does not guarantee transparency in the management of resources by centralizing health funds in a single public entity without the necessary audits, and they criticized the lack of a national consensus, by not taking into account It does not take into account the concerns of civil society, the requests of patients and users, nor the proposals of experts and actors in the system.
The senators concluded that they would not support a reform that, in their opinion, compromises the achievements of the Colombian health system, considered one of the best in Latin America, and puts the well-being and health of the population at risk.
The most notable elements of the negative presentation of the health reform
The document filed for debate consists of 177 pages and 20 sections. Some of the most relevant arguments are the unresolved problems in the government’s health reform, the lack of conclusive information about the financial impact it would represent, and the errors materialized in the articles.
“There is an attempt to confuse, in the proposed reform, mentioning article 4 of the Statutory Health Law, 1751 of 2015, without concretely, efficiently and directly updating the public social security health service, from the perspective of insurance and not of welfare, to achieve in this way the tasks of the statutory law, it is considered, on the contrary, that this reform ignores the advances of the general social security health system as an irreducible starting point to achieve the achievement of the right to health.can be read on its first pages.
For the senators, the health reform lacks concrete evidence that ensures a significant improvement in the provision of services, nor does it guarantee the complete overcoming of the deficiencies present in the current model. On the contrary, there is a risk of a setback in the right to health of Colombians, due to the ambiguity in the assigned responsibilities, the lack of effective tools to guarantee the rights of users, and an excessive dependence on development and efficiency of health service networks, without a clear projection of their successful implementation. This could increase the demand for more human, economic and technological resources, without providing the necessary means to ensure the quality of the health service.
Additionally, they question the increase in responsibilities that would be assigned to the Ministry of Health and ADRES. The health portfolio would be in charge of enabling networks and CAPS, sectoral and intersectoral coordination, and monitoring and controlling contracts with health entities of varying complexity, making the Ministry a simultaneous entity: regulator and operator, requiring a process of institutional strengthening and restructuring. However, this expansion and restructuring process does not have the necessary budgetary support, since it does not have the fiscal guarantee of the Ministry of Finance and Public Credit.
In the government’s health reform, the ADDRESS would become the sole payer in the system, despite its history of non-payment and inefficiency. This modification proposes the payment of 85% of invoices without a prior audit, a practice that deviates from the current model where EPS assume the risk and guarantee the provision of services after a careful audit. This new payment methodology without prior verification increases the risk of misappropriation of health resources, endangering the financial sustainability of the system and the quality of the service offered to Colombians.
The dilemma in the use of system resources also does not offer any clarity. “The EPS assure that the UPC and the PM are not enough and that the calculation used by the Government in defining these values is not considering the real behavior of spending. For their part, the IPS and health technology providers state that the EPS have an enormous debt that is affecting their sustainability. The National Superintendent of Health mentioned that the EPS debt amounts to nearly $11 billion (data delivered in the session of Commission VII held on March 6, 2024).”
In this regard, the senators do not propose an unknown strategy. The solution involves adjusting the UPC calculation and redistributing resources based on the risks of EPS affiliates. The Constitutional Court has suggested that the State must pay debts to insurers.
How does the Petro government’s health reform fall short?
In the negative presentation, the senators present a list of the fundamental problems of the system that the health reform would not solve. Among the issues pending improvement are:
- The single information system, based on what already exists, SISPRO, RUAF, LUPA AL GIRO, improve and strengthen it, there is no need to create another, make it compatible with the interoperable clinical history, update what already exists.
- Require optimal Health Accreditation from the EPS and guarantee of payment to creditors in the event of liquidation, so that they comply efficiently and in a timely manner with the guarantee of the health of Colombians. Creation of a fund that guarantees payment in the event of eventual liquidations.
- Promotion, prevention and care in the rural sector. Assign to a single EPS, rural care with differential UPC and with incentives for quality in care, promote telemedicine, establish a contracting limit with ESE at a minimum of 80%, include transportation and lodging expenses in maximum budgets with direct transfer.
- Improve health personnel, in hiring, payments and working conditions. Establish salary scale for human talent in public health, dates and percentages of increases, incentives for providing services in remote areas.
“The transformations of the current system, postulated in the reform approved in the second debate, disintegrate the current insurance model, hence it must be exhaustively clear and concrete in the way in which the implementation of the primary care proposed in this model is proposed. , the tools, those responsible for achieving it and the deadlines, which, throughout the approved text, are absent in this bill”affirms the group of senators who filed the negative presentation.