2024-01-16 07:01:00
The new year 2024 does not seem to bode well for the relationship between the health promoting entities (EPS) and the national government. Or at least that is what is predicted by the new front of the fight that the Ministry of Health opened this weekend with a popular action that was filed before the Administrative Court of Bogotá against 21 EPS (among which are Compensar, Sanitas and Sura).
The reason for this judicial move is that the ministry indicates that these insurers are failing to comply with the obligation to invest technical reserves, which ends up affecting timely access to health services for members who require it. Technical reserves are a requirement that EPSs must meet to have enough money to guarantee payment to health providers (clinics, hospitals, laboratories, etc.) that serve their users. It is a financial support that is handled in the insurance business and is used as a fund to pay high demands for services.
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According to the health consultant, Ramón Abel Castaño, the EPS support these reserves with 90% of the money that the Health Resources Administrator (ADRES) transfers to them monthly to provide care to their members and which is known as a payment unit. by capitation (UPC). The insurer must “have that percentage backed by short-term, highly liquid investments.”
The fact is that for the Ministry of Health, this noted non-compliance puts at risk the defense of public assets, administrative morality and access to public service to social health security, as stated in the popular action. Therefore, he asked the court to order the EPS to “avoid contingent damage and put an end to the danger, threat, violation or injury to collective rights and interests.
The annoyance of EPS
This judicial action by the ministry is unprecedented in the history of the health system, which has been built for 30 years since Law 100 of 1993.
For the Harvard University researcher, Johnattan García, it is difficult to save that financial support as the situation of the system is at this moment: with the EPS demanding more resources at the UPC, pointing out that they do not have enough for the demand for health services. current, and with the ministry insisting that these resources are sufficient.
“The EPS receive money and it is only enough for health benefits. There are so many expenses that we cannot save for technical reserves,” said the expert.
Gestarsalud – the union that brings together the insurers of the subsidized regime – expressed this Monday that it will not “give an opinion regarding the legal action since the objective of the lawsuit is not clear.” Likewise, he said that “he has promoted dialogue with the National Government to advance improvements to the health system and has been reiterative that there are legal mechanisms to confront this type of illiquidity situations, which the Government has not yet considered.”
For her part, the executive president of Acemi—the EPS union of the contributory regime—, Ana María Vesga, expressed her discomfort and pointed out that the Minsalud “appeals to inaction and now to judicial actions and denies the health system the technical dialogue that it requires”, a situation that for her affects “millions of Colombians who are beginning to see that the explicit crisis is real.”
Does the demand have a future?
Researcher García points out that such a popular action can take years to be resolved and also “does not ask for precautionary measures, which shows that the decisions that may arise are not urgent and that it is more to deliver a media coup.”
Meanwhile, Ramón Abel Castaño points out that when a substantive decision is reached, the Government could shoot itself in the foot “if a judge orders them to be liquidated and those debts are transferred to the Government.”
Meanwhile, the health sector is with its hair standing on end waiting for what happens since March in the Senate, where the two debates that the health reform needs to become law will take place.
Which EPS do not comply with technical reserves?
According to the popular action filed by the Ministry of Health, by September 2023 the Superintendency of Health identified that the EPS of the contributory regime Sura, Sanitas, Compensar, Famisanar, Comfenalco Valle, the Social Liability Fund Ferrocarriles de Nacionales, Western Health Service and EPM did not comply with the investment regime indicator.
Likewise, the EPS Capital Salud, Savia Salud and Capresoca do not comply with the subsidized regime.
In the mixed insurance companies (subsidized and contributory), there is Coosalud; while those that have an institutional reorganization or financial adjustment plan include Nueva EPS, Emssanar, Asmet and Cajacopi SAS.
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