Transformation of EPS and responsibility for financial risk, doubts about the reform

Within the framework of the discussions on the health reform, which has already been filed and for which spaces are being opened, according to the Government actors “for the purpose of concertation”, Some concerns continue to be revealed about the proposed articles and the future of system financing.

(See: After a technical table, health sector actors call for a consensus on the reform)

For this occasion, in the public hearing of the reform in Congress, different experts and actors in the region assured that the well-defined roles of each of the actors, the work of the IPS, medicines and the transformation of the Health Promotion Entities (EPS), They continue to be causes of concern within the discussions.

Initially, Cristian Stapper, vice president of litigation, environment and external relations at Fenalco, highlighted the problem of definancing that has been evident within the Colombian health system. He mentioned that today the maximum budgets for 2022 and 2023 remain unpaid, where the adjustment that was made in January and June was not enough.

(Read more: In four years, spending on voluntary health plans has increased 68%)

For this reason, the vice president questioned the way in which it is planned to finance or determine the budget required for efficient and effective operations. that is being proposed in the new health reform proposal.

“It is essential to determine how the portfolio is managed and who will be responsible for contracting health services. It must be taken into account that in the territorialized plan of the service it is observed that everything becomes public. This discussion must take place in a much deeper way, because there are good or bad public or private service providers and there is great concern about the eventual bureaucratization of the system if it becomes completely public.”, he indicated.

(See: What are health actors asking for to solve the current crisis in the system?)

Another focus of concern stems from the transformation of the EPS into health and life managers. In that sense, Manuel Antonio Galindo, representative of the National Academy of Medicine, pointed out that Within the Government reform, membership is not being included as one of the functions of the managers, since they are only being assigned their participation as auditors for the validation of invoices. Added doubt about the coordination of the managers with the Caps and the departmental and municipal secretariats.

(See: EPS Famisanar announces action plan after extension of administrative intervention)

“For this work, which represents less work than what they currently do, they will receive between 5% and 8% of the value of the UPC, which is an interesting and large amount of money. We propose that managers can be public, private or mixed and that they must have assurance functions. We do not agree with an eminently state health system”, he opined.

Galindo also explained that these new EPS should also be in charge of health and administrative risk.while the Adres should bear the responsibility of assuming the financial risktaking into account that this will be the entity in charge of directly sending payments to the IPS.

(Also read: They warn of risk of collapse in recognition of resources for high-cost diseases)

“The managers must have the power to contract the services with the integrated health services networks, IPS or independent professionals, without prejudice to their competence to audit, validate the invoices and authorize Adres as a single payer, in application of direct transfer, to avoid financial intermediation”, he indicated.

(Read more: ‘Large investments deserve a pause due to uncertainty’: Marly Clinic)

Precisely regarding the discussions of who assumes the financial risk, Strapper explained that it is necessary that the person responsible for this be explicit within the articles, understanding that although the resources are public, they should not be limited.

For his part, Julio Cesar Castellanos, representative of the Bogotá Health Cluster, reiterated the message that the greatest concern is the financial sustainability of the health system, but also added that The situation of home IPS is not contemplated within the reform project.

(See: Health reform: they urge not to throw away the public-private experience)

According to the actor, some of these institutions are top-level, and are not mentioned in the articles, which would imminently condemn them to the possibility of being part of integrated health networks disappearing.

He added that “The fifth article establishes the formation of the National Health Council, but does not include the presence and participation of service providers, which worries us greatly. We may be uncomfortable in discussions, but I think we are the institutions that should participate the most”.

(See more: What are the EPSs that are in the process of withdrawing from the health system)

In turn, Agamenón Quintero, president of the Colombian Association of Scientific Societies, stated that within the current system, and even the one that is intended to be modified with the reform, it is necessary that The working conditions of the medical report guarantee stability, security and continuity.

“It is not in this bill, they removed it. I think we have earned having that labor system. This regime, among other aspects, must include the preservation of the administrative career, timely payment and daily working hours. That we have a decent job again”, he expressed.

(Read: Health financial crisis threatens to worsen drug delivery problems)

The pharmaceutical industry

Currently the country has at least 98 pharmaceutical production plants which are responsible for supplying 80% of the medications consumed within the Colombian health system.

(See: The New EPS suspended payments to 144 IPS due to inconsistencies in invoices)

In this context, Clara Isabel Rodríguez, director of the Colombian Association of Pharmaceutical Medicines, assured that within this area there is a specific concern regarding financing, Well, 30% of the UPC should be allocated for drugs, but within the text nothing is proposed regarding the allocation of resources.

“Today we are facing a crisis of drug shortages at all levels. And this has nothing to do with the lack of national production, but with the problem of the flow of resources where this reform project is not providing a clear solution in this regard. We hope that there is clarity in the health reform regarding how financing is going to occur and how intermediation is generating additional spending.”, he highlighted.

(Read also: Resources for high-cost diseases, at risk due to low tax collection)

He reiterated that the direct transfer contemplated today within the decree promoted by Adres to pay for the medications owed is not directed directly to the laboratories that make the medications, but rather to the intermediaries. This would mean that the institutional channel cannot be properly supplied.

(See also: Adres has transferred $49.46 billion from UPC from January to July)

Along the same lines, Carlos Francisco Fernandez, president of Asinfar, estimated that currently Spending on medicines in Colombia has increased by 24.73%a figure that is consolidated as dramatic for the Colombian system.

“We have dared to talk about a pharmaceutical policy where access to medicines must be guaranteed at all levels of care. Now that they are talking about the Caps proposal, it is important that from there there is naturally an element of projection, establishing the guarantee of the provision of medicines in terms of quality, sufficiency, timeliness, but also sustainability of the system.”, he concluded.

(Read: Household health spending rebounds while the system deteriorates)