If lateness and last minute changes do not appear again, this Monday the so-called structural reform of the health system arrives in Congress. At the same time, the country is convulsing in the middle of a week full of marches against this project by Petro, who until now has not been able to bring him down to polarization.
The truth is that it is one of the president’s most ambitious and controversial proposals. Even without knowing the final articles, the lack of clarity and the repeated contradictions have unleashed the greatest resistance from the political parties that support him in the Capitol –in addition to the Historical Pact– and even within the same ministerial cabinet.
However, as the months passed, Petro’s speech and positions have lowered the foam and the path of consensus has been chosen, which was reflected in the fact that the Government abandoned the idea of eliminating the EPS.
Not surprisingly, with all the bad publicity given to it, the Colombian health system has the backed by several indicators that place it as one of the best in the continent, with the capacity to, in one year (2022), have provided assistance to 42,496,766 people, guarantee 309,332,806 services and manage 33,244,270 specialized consultations (see box).
These are the main points of the changes that, for the moment, have been known from the statements of Minister Carolina Corcho.
How will health resources be managed?
The change in the administration of resources (financial intermediation) would no longer be in the hands of the insurers. For the Reform Promotion Committee, the model has been a “failure” and “they have not complied with the legal requirements”Therefore, it is not worth “continuing to transfer public resources to private operators.”
However, part of this change in Petro’s ways was reflected last Friday night after a meeting with the presidents of various health care providers (EPS), in which Corcho and Interior Minister Alfonso Prada participated. . At the end, the latter assured that “the project, under no circumstances, eliminates the EPS nor does it put a subsistence transition term on them” and that those that “accommodate the new design of primary care centers will have the possibility of continuing.”
In turn, the health director of Compensar, Andrés Barragánexplained that Petro “He did not talk about eliminating the EPS, but about transformation” and said that they stated that they left “a series of doubts about the future of the health system in Colombia.”
On the other hand, the idea is that control of the resources is held by the Administrator of the Resources of the General System of Social Security in Health (Adres).
Preventive and predictive: the new approach
This is the point at which there are more agreements between the Ministry, the experts and the health actors. Currently, the health model in the country focuses on treating the disease and not on avoiding or predicting it. Therefore, the claim of the National Government is to transform the model into a preventive and predictive one. This way, A network of comprehensive services would be created with which family doctors can recover and to give importance to social factors that allow citizens to develop and have a healthy state of health.
Commitment to improve working conditions
The situation of health professionals and their labor relationship, in which contracts for the provision of services abound, is the center of this point of the reform. That is why it is sought improve their conditions in salary and contractual terms, which ensure fair and stable conditions for their training and education.
Mayors and governors take the reins
In this regard, the claim of the reform is that decentralization and citizen participation are essential conditions to guarantee that territorial governments (mayors and governors) assume control of the living and health conditions of citizens through dialogue with them.
How to finance health and social security?
For the Executive, the subsidy of the health and social security system must go in three lines. First of all, andThere are companies, workers, independents and capital rentiers must contribute to parafiscal funds; secondly, companies in proportion to the contracts made for personal work or services; and thirdly, workers and rentiers in proportion to their income.
Build a public information system
The idea of this is to develop a unique information system, public and available online that allows the economic, clinical, scientific and administrative information of the current health system to be retrieved in order to preserve economic and epidemiological resources. To this end, the necessary data will be included to guarantee information on individual, demographic, health determinants, genetic and clinical components, including diagnoses and results.
What will the red lines be?
Those two words –red lines– have been the favorites of the political parties (La U, Liberal and Conservative) that have publicly exposed their fears regarding the health reform and that have made the Government stop along the way. However, these immovables are shared by some connoisseurs of the system.
One of them is the former Minister of Health Fernando Ruiz, who told EL COLOMBIANO that “the most sensitive point is the issue of insurance and that they are going to maintain it, and the rest is more of a financial nature and the transition regime, the most important thing is whether the insurance model is going to be maintained.”
For his part, the movement’s spokesman Colombia Patients, Denis Silva, expressed to this newspaper that the immovable should be “non-regression, regardless of the change there is; the protection of the system and not of the EPS; as well as financial protection.
Abecé of the doubts that still remain due to the changes in the system
Although the EPS received with hope the report delivered by Minister Prada on the non-elimination of the EPS, there are still several concerns that they hope to resolve this Monday with the filing of the reform and which were expressed by the union of subsidized EPS, Gestarsalud.
A single entrance door
For the union, the primary care centers (CAP) would have to provide basic services to between 20 and 25 thousand people, which could increase waiting times and congestion, as users would have fewer access channels to receive medical attention.
Will health spending skyrocket?
According to Gestarsalud, in the proposed model there would only be a single payer because, they say, no one would control or audit spending and the system would be at risk of bankruptcy and “without the EPS we will spend much more than now.”
Other information system?
The union argues that currently there are other robust databases in the ADRES, the EPS, the IPS, the High Cost Account and the Ministry of Health. Given this, they propose that all the existing information is interoperable and that it includes the clinical history.
How to guarantee better salary?
The what is clear. The how is missing. To solve it, adds Gestarsalud, it must be clear how many workers there are, how many are precarious and the cost of formalizing their contract directly with the State.
That being said, either due to pressure from the parties that support him or because he came to his senses, President Gustavo Petro took command of the dialogue to move forward with the reform, in which his governability in Congress is at stake. In this sense, former Minister Ruiz assured that this “is a step in the right direction” and that “this reform should have started there”; although he warned that it shows a short circuit between a Petro “with a conciliatory and pragmatic tone and a Ministry with a different and radical tone.”
Likewise, Silva asserted that he is concerned “That the government is making the minister invisible because it canceled her from the talks and they were led by the president and Prada. All of that has a background.”
Meanwhile, Ana María Soleibe, spokeswoman for the Health Reform Promotion Committee, told this newspaper that this situation corresponds to some guidelines that are from the Presidency and that in the meeting with the directors of the EPS Corcho “was in charge of making the pedagogy of the reform”. In addition, she described as “very positive” the announcements of that meeting in which it was made clear that “EPS can adjust to the new system as health providers.”
Without going any further, the health reform will continue to bring with it intense weeks of debate, discussion and consensus. Meanwhile, the Government seems to have given in with the idea of eliminating the EPS, but the question arises: Will it have the same character in the face of other concerns?
