THE Resource Administrator of the General Social Security Health System (Adres) reported that it took place for the month of September $7.11 million to Health Promotion Institutions (EPS) for Unit Capitation Payment (UPC)of which 3.37 billion dollars for the subsidized regime and 3.63 billion dollars for the contributory regime.
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According to the information disclosed by that entity, of the total assets transferred For grant aid, $2.54 billion was delivered directly to 3,315 healthcare delivery institutions (PSIs) and other service and technology providers, while the rest 816,000 million dollars were donated to the EPS.
On the other hand, of the total resources provided For the contributory portion, $2.09 billion was awarded to 2,762 IPS and healthcare providers, while $1.35 billion was awarded to EPS.
It is worth remembering that the UPC is the name by which the money is known that the State, through Adres, gives to insurers for each of its members, with the aim of using that money to guarantee the required healthcare.
Furthermore, the institution reported that for the same month has allocated 135,000 million dollars for the recognition of disabilities due to general diseases, 45,000 million dollars allocated for the development of activities for the promotion and prevention of diseases and $100,000 million for 10,941 maternity leaves, 6,173 paternity leaves, and 118 guardianship action rulings.
So far this year, Adres has directly transferred a total of $33.51 billion to IPS and suppliers, which represents with an increase of 111.82% compared to what was recorded in the same period of 2023.
The IPS and service providers that benefited most from the UPC payment were the Colombian Family Subsidy Fund Colsubsidio, Droguerías y Farmacias Cruz Verde and the Cafam Family Compensation Fund.
The value of the UPC and its increase are defined at the end of the year for the following one. That is, the increase for 2025 is established in December of this year. Indeed, Its increase has been a cause for discussion and debate between Gustavo Petro’s government and the EPS, health experts, academics, patient groups and opposition members of Congress..
While the latter argue that the UPC cannot meet the demand for services currently required and this puts the EPS in difficulty, the president and his health officials argue that it is sufficient and that they have increased it accordingly. to needs.
Indeed, regarding this debate, Senator Paloma Valencia (Democratic Center) revealed on Tuesday the financial statement data of the Nueva EPS, the country’s largest insurer with 10.8 million members. According to the information he revealed, after obtaining the protection of this company, for every 100 pesos that enter the entity on behalf of UPC, 126 pesos are spent.
“The UPC (Capitation Payment Unit, which is recognized annually by each of the members) is insufficient. We have been saying this since Carolina Corcho denied it in 2022. The crisis of the system is a liquidity crisis,” the deputy observed in this regard.
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Interview between Time.news Editor and Health Finance Expert
Time.news Editor (TNE): Good afternoon, and welcome to our interview series where we discuss critical topics affecting public health and finance. Today, we have with us Dr. María Gómez, a renowned expert in health economics and policy. Thank you for joining us, Dr. Gómez.
Dr. María Gómez (DG): Thank you for having me! I’m excited to discuss the recent data released by Adres regarding healthcare funding.
TNE: Absolutely. Just this September, Adres reported transferring over $7 million to Health Promotion Institutions, split between subsidized and contributory regimes. Can you break down the significance of these figures for our audience?
DG: Of course. The allocation of $3.37 billion to the subsidized regime and $3.63 billion to the contributory regime is quite substantial. It indicates a significant financial commitment to ensuring that all individuals, regardless of their income level, receive access to necessary healthcare services. The fact that Adres distributed over $2.54 billion directly to healthcare delivery institutions means they are investing heavily in frontline services.
TNE: That’s an important point. How does the Unit Capitation Payment (UPC) system work, and why is it crucial for health insurers?
DG: The UPC is essentially the payment model used by the Colombian state to reimburse health insurers for each member they cover. It aims to ensure that the funds are utilized appropriately to meet the healthcare needs of the population. This financial structure is designed to promote efficiency and incentivize insurers to provide quality care, as their funding is directly tied to their performance and patient outcomes.
TNE: Interesting. We also read that there was distinct funding for specific initiatives such as disability recognition, disease prevention activities, and various leaves for parents. Why is it critical to fund these specific areas?
DG: Funding these specific initiatives is vital for a holistic approach to health. By allocating $135 million for disability recognition, for instance, we’re acknowledging the realities that many face, ensuring they receive the support they need. The $45 million for promotion and prevention activities highlights the growing understanding that preventing illnesses is just as important—if not more so—than treating them. supporting maternity and paternity leaves with $100 million acknowledges the role of family health in overall societal well-being.
TNE: This year alone, we’ve seen a whopping increase of 111.82% in direct transfers from Adres compared to last year. What does this indicate about the current healthcare landscape in Colombia?
DG: This dramatic increase is indicative of a response to the urgent healthcare demands that arose during and after the pandemic. The government appears to be prioritizing health investments to strengthen the system, possibly as part of a larger strategy to reform healthcare. Increased funding can lead to improved healthcare access and quality, which are essential for a thriving population.
TNE: Speaking of reform, President Petro is currently advocating for changes to the EPS. How might these proposed changes impact the current funding dynamics we’ve discussed?
DG: President Petro’s push for reforms could lead to significant shifts in how funding flows through the system. If successful, it could enhance the oversight and accountability of EPS, ensuring that funds are used efficiently for patient care. This may also lead to a more integrated health system where funding is more equitable, thereby improving access to health services for underserved populations.
TNE: It seems like we are on the cusp of some transformative changes in the healthcare system. Thank you, Dr. Gómez, for sharing your insights with us today. Any final thoughts?
DG: Just that the ongoing developments in healthcare funding and policy in Colombia will need close monitoring. It’s crucial for all stakeholders—government, providers, and the public—to ensure that these funds ultimately lead to better healthcare outcomes for everyone.
TNE: Thank you once again, Dr. Gómez, for your valuable insights. We look forward to keeping up with these developments and hope to have you back for further discussions.
DG: Thank you! I would be delighted to join again.