The introduction of the health reform to Congress last Friday generated criticism, discouragement and concern among the actors in the sector, who claimed that the new text is “very similar” to the one that was rejected by the Senate in the previous legislature.
(See: Were health sector stakeholders taken into account in the new reform?)
Although primary care remains the Government’s flagship in this ‘new’ project, the truth is that the biggest point of concern is the financing and sustainability of the Colombian health system.
According to the text, the projections made by the Ministry of Health and the Ministry of Finance They foresee that System resources are obtained from four sources: contributions, contributions from the General Budget of the Nation (PGN), the General Participation System (SGP) and other sources. Within these calculations, only for 2025 the system would need $99.6 billion, of which the largest amounts correspond to contributions with $34.4 billion and contributions from the PGN with $38 billion.
It is worth noting that the resources needed for the sustainability of the system will grow progressively and the latest estimate is for 2034,n where the sector will need to finance itself with $156.6 billion.
The director of Así Vamos en Salud and former minister of the portfolio, Augusto Galán, assured that in the review of the new project a deficit of at least $3.9 billion was estimated for the system’s budget by 2025.
(See: Former ministers and vice ministers of health reaffirm concerns about the reform).
“With what the Government has presented, this financing for next year would have to be revised, not counting the debts that have been accumulating over the years. How will next year be financed in the midst of the crisis we are currently experiencing?“, said.
However, the Ministry of Health itself recognized in the document the effects of fiscal constraints, since the difference between the income path presented to Congress in March, That is, in the previous reform, “This year is very noticeable“, given the new fiscal restrictions resulting from the decrease in the nation’s income.
As a result, he assures that there is a “slight” reduction in the SGP resources, added to a decrease in the PGN, especially in the 2026 estimate, with a growth of 3.7%, compared to the 12% estimated for 2025.
“This results in a reduction in the base for calculating the following four years, which together reduces total revenue by $31.7 billion compared to the March 2024 revenue projection exercise.“, they say.
It should be noted that in a letter addressed to Minister Guillermo Alfonso Jaramillo, several former officials of the portfolio reiterated that the lack of funding for the sector requires an immediate solution.
They illustrated that within the current crisis, unmet demand has increased to such an extent that the number of guardianships has increased. 42% when comparing the first four months of 2024 with the same period last year.
In addition, they warned that with the spending behavior in the month of June, an additional minimum incorporation of $2.5 billion will be required to guarantee the rotation of the Capitation Payment Unit (UPC).
(See: The health sector crisis continues to intensify: what is happening?).
“In addition, not all of the overdue debts for the year 2022 on Maximum Budgets that the Constitutional Court ordered to be paid have been settled, those for 2023 have not been fully cancelled and the disbursements for that concept for the remainder of the current year are in doubt.“, they said.
Do you accept cuts?
Although in recent days and given the country’s fiscal situation it had been said that the budgets of the Health, Education and Defense sectors would not be touched, within the text the same portfolio accepted that adjustments had to be made in the expenses presented, compared to those of the previous text.
In detail, the ministry noted that the only possible strategy to fit the reform projections into the new, more restrictive revenue framework was the more gradual implementation of the core elements of the reform, especially to adjust the reduction in revenue between 2026 and 2029.
For this reason, they reduced “moderately” the growth rate of primary care resources between those years, but without reducing the final goal. “Spending on primary care as a percentage of health care expenditure will rise over the ten years projected in the path, from 21% to 28%, approaching the 30% target recommended by the WHO,” they indicate.
Also, the transfer of departmental income to strengthen State Health Institutions or public hospitals is made more gradual, the first four years after the law is issued, This means prioritizing the first few years of hospital institutions in regions of the country with a more dispersed population and geographical barriers.
(See: This is the proposal of health professionals for the reform of the sector).
“A slower growth in quality incentives is projected, adjusted to the EPS transition scenario, and it is estimated that from 2028 the incentive will be in full force, so that all medium and high complexity managers or IPS can achieve the three incentives established in the Law,” says the text.
Analyzing the income and expenditure paths, at least from 2025 to 2029 the system will spend almost 100% of the total income to the system. For example, for next year it is estimated that Total income is $99.6 billion and therefore spending is exactly the same amount.
“Health is not properly budgeted and that is where the underlying discussion lies, which has not been wanted because it is politically complex. As a society we have to address it, because we cannot continue telling ourselves lies. Either we budget better and look for adequate financial resources or we have to make decisions.“, concluded Galan.
DIANA K. RODRIGUEZ T.
Portfolio
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