The health reform has left several details that have not been easily understood in the country and one of them is the role of the new EPS that will regulate the entire health system at the national level.
Questions about this new model have revealed a reality: the contrast with the current health system created by the law 100 compared to the new paradigm proposed by the president Gustavo Petro It has numerous points found: infrastructure, coverage, service capacity, the future of the beneficiaries and taxpayers of the different health promoting companies and, above all, the regular channel at the time of requesting a medical appointment.
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These changes are explained in the Health Reform document, which is made up of 152 articles and 18 chapters, which detail, very clearly and concisely, all the transformations and panoramas of said proposal.
The EPS that are currently in force are going to have a transfer of their functions, that is, they will go from being health promoting entities to being health service provider entities.
(Keep reading: Health reform: what Petro could do if they approve the project).
Its functions, as explained by the former health minister Augusto Galán to Portafolio, would pass into the hands of multiple entities, such as the Primary Care Centers (CAP), the regional health funds and the Administrator of the Resources of the General Social Security System. in Health (Adres), but that, despite this, were not clear in the wording of the proposal.
“If this law is approved as a law of the Republic, the transition described in the articles leaves too many gaps. What is proposed there is as a transitory measure| while the entire population passes to the State. So, the EPS, as we have it today, in theory, would subsist for a while, during which while an EPS disappears, that affiliated population would pass to the new EPS, and that new EPS would be handing over the population to the State”.
(You may be interested in: Health reform: what Petro could do if the project is approved).
In summary, All this framework removes the total responsibility of the EPS and the functions would become that of a state conglomerate in a staggered manner: from the local to the national.
One of the key points of the reform is the segmentation and assignment of the functions of the current EPS to government departments.
Press David Racero
Is it the most confusing thing about the reform?
From the beginning, President Petro had as one of the flags of his campaign to the executive the elimination of the EPS as they are known for Colombians to move to a single health system controlled by the State.
This was one of the most controversial points, even after Petro assumed the presidency, since there was confusion about what was going to happen to the people who were affiliated with health entities in all their regimes, in addition to what the health service would be like. patient care.
(Also read: This would be the transition to the health system proposed by the reform).
An example is that of complaints, since this new reform, according to the professor at the Universidad del Rosario Paul Rodríguez Lesmes, It is not clear about an instance to which to turn when expressing disagreements with the service.
“Before, I could go to the EPS, put a guardianship on him and say ‘you are to blame’. In this new mess of actors that is being presented, into which the EPS would enter in some way, we do not know who to complain to, that is, we do not know who is that person who is leading and who is responsible for ordering the spending, and That’s going to cause us a lot of trouble.”.
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In addition, Rodríguez also added that one of the scenarios in which this uncertainty can occur is the patient’s compliance with the model proposed in the reform.
“Today I can join an EPS and if I don’t like it, I can move to another. In this new system. This new system in which these primary care centers enter, I’m only going to have that point of contact and if things go wrong, I can’t do anything about it and I don’t know who to complain to”.
Human talent is one of the points that the reform seeks to strengthen.
Milton Diaz / EL TIEMPO
Within health systems, it is common to take into account different aspects such as human capital, the coverage and, of course, the budget that is required to fully fulfill its functions.
(Keep reading: Health reform confirms the fears of the EPS).
That is why, according to what is proposed in the reform, the working conditions of Colombian doctors have to be improved to give added value to the service provided.
“On the subject of human talent, the point is very focused essentially on defending the salary conditions of human talent, since it is an invaluable resource, since it is the most important in the health system; and it seems to us that the approach is falling short, because we need to improve information profiles, we need a national health human talent policy that includes aspects of training profiles and relevance in training, aspects of an adequate redistribution of human talent in the territory and, of course, aspects of decent working conditions for human talentGalan said.
(In addition: Members of a single household must be enrolled in a single EPS?).
For his part, Rodriguez mentioned that the resources monopolized by the Government also have some very important challenges. the expense that the Government can afford for this new model, in comparison to the current one.
“Colombia, at this moment, manages to buy health services from first world countries, being a country that is not from the first world. That is the diagnosis that one could give in terms of the use of the country’s resources. Our health benefits plan is incredibly generous. It is an open list to everything that is not on an excluded list, which is quite -commented- What happens if the money is short and if these waiting lists are quite long? Well, simply, we have to pay out of pocket, and that is not unusual in the region. That achievement that we have in the country is what would be at stake”.
The reform document, according to the former minister, was not clear and deep enough with respect to the aforementioned ‘Master Plan’ that would develop the infrastructure field in this new model.
“The reform proposes a master plan that we do not know how much it will cost, nor how it will be developed. There is simply a statement, but there is no clarity of what that infrastructure master plan means. There is a lot of generality on that topic.Galan mentioned.
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