The lack of financing in health also affected the public Health Service Providing Institutions (IPS), in the midst of the difficult economic situation that the Colombian system is going through.
(See: Health system crisis: the dangers of defunding and deterioration in care)
The Así Vamos en Salud think tank revealed that the main challenges of these institutions are largely framed in critical areas such as budget imbalance, the operation of the State Social Enterprises (ESE), which harm their functioning and that end up impacting patient care.
In budgetary matters, Así Vamos en Salud highlighted that The total portfolio of ESCOs shows an upward trend between 2018 and 2023 of 47.4%reaching a total debt of $12.4 billion this last year.
(Read: EPS Sanitas begins third phase of change of pharmaceutical suppliers)
Within the period analyzed, since 2020 the upward trend has been maintained, but it was in the period from 2022 to 2023 where The increase in the portfolio reached its highest level, jumping 16.6%, from one year to the next.
In that sense, when observing the distribution of the portfolio by levels of care, it is estimated that number three concentrates 40.9% of the total debt in the last period (2023) with $5.07 trillion. Next is level two with $4.75 billion (38.3%) and level one with $2.57 billion (20.7%). “It should be noted that level 3 of attention concentrates the greatest value of the portfolio; is the one with the least amount of ESE with 6.7% of the total”says the report.
(See more: They warn that EPS financial statements continue to worsen)
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On the other hand, regarding the age of delinquency, during 2023, 55.2% of the portfolio corresponded to debts of more than 360 days, equivalent to about $6.8 trillion, while 13.7% between 181 to 360 days. Also, 17.6% had debts between 61 and 180 days, and 13.6% had debts of less than 60 days.
(See also: Financial crisis in Colombian health: EPS debt reaches $18.9 billion)
At the three levels of care, it is observed that the portfolio of more than 360 days is the one with the greatest participation, with a higher concentration in the third level. reaching a value of $2.9 trillion, equivalent to 43.3% of the total debt older than 360 days. In second place is the portfolio from 61 to 180 days, which represents 17.6% of the total and corresponds to $2.1 trillion, of which 41.8% belongs to the second level of care.
If the information is analyzed by type of debtor, the think tank detailed that The subsidized regime is the one with the highest proportion of portfolio debt at 55.3%corresponding to $6.86 billion. Followed by the contributory regime with 20.3%, which amounted to $2.52 billion.
(Read: Appointment assignment, the main barrier for patients to access health services)
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This explains that both the subsidized EPS and the contributory EPS have 75% of the total portfolio of these entities. “It can be seen that the composition of the type of debtor at each level of care is similar; that is, the Distribution of the portfolio by type of debtor is distributed similarly at each level of care,” they mention.
(See also: Supersalud intervenes EPS Coosalud due to administrative and healthcare deficiencies)
In the analysis of budgetary expenditures during recent years, a defined trend is observed in the distribution of resources and a significant growth of the committed budget.
On average, Operating expenses have represented 63.7% of the total throughout the analyzed period, consolidating itself as the main budget item. These are followed by operating and service provision expenses, which constitute 17.3%, and accounts payable from previous periods, with an average participation of 12.3%, remaining between a range of 11.8% to 12.8%, respectively.
(Read: In October, Adres allocated $7.13 billion for health insurance)
The committed budget has also registered notable growth. In 2019, it stood at $14.7 billion. However, for the years 2022 and 2023, this figure reached $19.8 billion and $23.8 billion, respectively, reflecting an average annual growth of 12.9%. This increase was particularly marked between 2022 and 2023, a period in which an increase of 20.1% was recorded, the highest in the time studied.
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Operation and risk
Now, another of the challenges that they point out in the report refers to the deterioration in the conditions of ESCOs to operate. Faced with this, it was revealed that there is a “marked” increase in these companies in the Fiscal and Financial Sanitation Program (PSFF), going from 190 institutions in 2023 to 281 this year.
(See more: Lawsuit against the Minsalud and Invima for shortages of medicines)
Of the total of the 281 ESCOs in PSFF measured for 2024, 19.6% (55) correspond to companies located in dispersed rural municipalities and 33.1% (93) in rural municipalities; This means that more than 50% of these are located in dispersed rural regions of the country.
Also, they categorized the risk, dWhere in 2024, 107 ESEs, representing 11.6%, will be established at the low level. Regarding the average risk, in 2019 and 2023 it remained at 41 and 43, respectively, and for the year 2024 it decreased by 48.8% with 22 companies.
(Read: They denounce shortages of medicines and deterioration in health services)
An analysis by department reveals that Antioquia is the region with the highest concentration of State Social Enterprises evaluated in 2024, representing 13.34% of the total, equivalent to 123 entities. They are followed by Boyacá with 11.39% (105), Santander with 9.0% (83), Nariño with 7.3% (68), Valle del Cauca with 5.7% (53), Cundinamarca with 5.5% (51) and Tolima with 5.3% (49).
Together, these seven departments concentrate 57.7% of the ESCOs evaluated at the national level, leaving the remaining 42.3% distributed among the other regions.
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ESE collection
The financial analysis of the country’s State Social Enterprises (ESE) reflects a worrying panorama, according to the research by Así Vamos en Salud, at the end of the 2023 term. According to the available data, The budget deficit amounted to $2.1 trillion, while in 2022 a deficit of $1.8 trillion had been recorded. These figures exclude accounts receivable and payable from previous periods.
(See more: Health reform: accounts that Andi makes about the impacts that the project would have)
When these accumulated accounts are included, The deficit registered in 2023 is $905,830 million, compared to $387,966 million in 2022, which represents an alarming increase of 133.5% in just one year.
Regarding the collection capacity in relation to the income recognized by levels of care, the results are also disparate. During the terms of 2022 and 2023, The first level of care showed the highest collection percentage, reaching a solid 83.2%.
(Read: Andi’s warning: health reform would generate a deficit of $163 billion)
This performance, they highlight, considerably exceeds the second level, which recorded a collection of 64.1%. For its part, the third level reached 69.4% in 2023, evidencing a moderate improvement but insufficient to compensate for the global deficit.
“This report seeks not only to provide clear tools to understand the financial landscape of public IPS, but also to empower citizens and promote constructive dialogue to move towards a more transparent, sustainable and equitable system.“, they concluded.
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