The Final State? Colombia’s Health System Crisis Is Worsening / Analysis by Ricardo Avila

Any medical report form, one of the ones available online, would say that. “The patient’s condition is very serious, and despite the treatments applied, his vital signs are deteriorating with other organs affected by the disease.”But here it is not about a person, but about the state of the health service in Colombia, whose current balance is frankly critical. The reason goes beyond the increasingly deteriorating financial situation of the stock exchange, which is the first link in the chain of the insurance model that is still in effect.

As we warned months ago, the domino effect has already hit other actors, including clinics, hospitals, and of course patients. The data speaks for itself.

According to the complaints and claims records kept by the Authority National Health SurveillanceSo far this year, the historic high has been reached with double-digit increases compared to the previous year, due to conditions such as barriers to access to treatment and medicines.

For its part, the August bulletin issued by the Así Vamos en Salud organization showed that in the first third of 2024, more than 84445 Guardianshipwhich is equivalent to growth 42% Compared to the same period of the previous calendar year.

“This indicates a deterioration in the guarantee of the right to health, at least from the point of view of the system’s users.”maintains the organization. In almost parallel fashion, the deteriorating financial reality of health service providers (IPS) has also reached record levels.

The portfolio report published by the Colombian Association of Clinics and Hospitals for 25 years concluded that until last December, these institutions owed 16.8 billion pesos, or about 16.8 billion pesos. 700,000 million More than a semester ago. This financial crisis is quieter than the stock market crisis, but it is no less serious.

For a wide variety of reasons, ranging from commitment to the Hippocratic Oath to fear of banks closing their doors in their face, most find it difficult to express their concerns individually.

“The prison service wants to continue operating and stay open.”“To do this, they must maintain good relations with their sources of income, seek payment agreements, and avoid radical decisions with their employees,” comments a manager from one of the country’s most important companies. “It’s not a myth: they are doing everything they can to survive, but they are about to run out of resources to buy supplies, and that will be the point of no return,” he warns.

getting worse

There is still a lack of data to adequately measure the impact of the economic crisis on the provision of health services. Increase in hospital beds in Colombia between 2023 and 2024, 100,961 to 101,547 (One percent), but it may be an indication that things are not so bad.

But other evidence suggests otherwise. A forthcoming analysis of news, social media posts, blogs and online comments reveals a 119 percent increase in references to incidents such as lack of liquidity, non-payment of staff, and service cuts or shutdowns at EBS. Headlines and press releases in recent months describe this phenomenon across the country.

In June, Santa Marta media reported that IPS Subsanar workers blocked Libertador Street due to non-payment of wages, and IPS workers reported the same. Vivisalud from Armenia And (Medicook in Cucuta).

In RiohachaEven pediatricians at the Nuestra Senora de los Remedios General Hospital have resigned. Meanwhile, doctors said IPS Viceroy Solis From Ibagué they protested that due to lack of resources, they had to treat patients in just five minutes. At the Foscal Clinic in Floridablanca, the profession 270 percent In emergency service, due to the closure of other prison services in the area. Similar cases have occurred in several population groups.

In contrast, earnings per share are going from bad to worse.A study by Sectorial.co showed that the ratio between expenses and income (technically called the accident rate), which should be less than 100, Reached 103 in 2021for 106 in 2022To 109 in 2023 and continues to deteriorate in 2024: in the first quarter it reached 113 percent.

Even entities that were well-run started the year on the wrong foot. This is what the accident rate of 125 percent in the surah or 100.7 percent in Total Health, whose picture reveals the extent of the current problems. As if that were not enough, the progress made by the entities that have recently intervened is worrying.

During last week’s Senate Committee 7 Policy Oversight hearing, it was revealed that the rate of new EPS incidents has risen dramatically to 151 percentWhich confirms once again that the state is very poorly managed.

Reasons

It cannot be ignored that the rise in many negative indicators has been going on for some time. Pointing to Gustavo Petro’s government as responsible for everything that is happening, and ignoring that there are structural problems that have been accumulating for several decades, would be unfair. Now, what can be criticized is the failure to deliver on the promise of reversing the trends and deepening the scale of the problem.

according to Andrew the neighbora health systems researcher, the difficulties in stopping the rise in red numbers can be attributed to the general lack of resources that has accelerated the vicious cycle of lack of money. But the one who will have the greatest weight “It’s the lack of financial will to correct the problems of the health system.” An example of this has just been noted.

In a letter addressed to the Minister of Finance, more than a hundred figures – including former ministers, former co-directors of the Bank of the Republic, former directors of national planning, debtors and colpensationers – asked the government to transfer 2.5 billion pesos from the Ministry of Health budget From the area designated for infrastructure and personnel in the regions to health insurance. According to the letter, the entity has taken the unprecedented decision to seize 5.05 billion “For uses other than those originally intended.”

If the redirection is completed, there will be no way to fulfill the pending transfers in the coming months, exacerbating the cash difficulties. Quickly, through your X account, President Gustavo Petro He refused to accept the request. He said that the annual amount per user of the system that the state provides to EPS was above inflation and suggested an improper use of the resources that these entities should have available to pay for services.

“There are tens of billions of pesos of lost technical reserves.” The President wrote. Such a response proves that despite messages aimed at seeking compromise solutions, the positions on the ground have not changed. Specifically, the government maintains the narrative that resources are sufficient and are being transferred in a timely manner by Adres to EPS and the hospital network so that they in turn pay the various service providers.

Count and play From this point of view, the financial problems are rooted in opaque money management, intermediation, inefficiency, corruption and vertical integration. The latter, according to the official position, creates incentives for conglomerates to transfer profits in the sector to their own clinics or to their prepaid health plans and leave expenses to the earnings of the stock.

For the executive branch, the usual flow is maintained and amounts to about seven billion pesos per month. According to Felix MartinezDirector Idris this entity “It is rotated with chronometric precision for supported system resources before the 10th of each month, and subscription system resources every week.”

In contrast, various academics, patient associations and unions insist on the need to pump more money, starting with the delay set by the Constitutional Court, which gave its instructions in this regard.

according to Anna Maria Vesga“Technical consensus on financing the system is essential, which must start with accepting that the UPC is inadequate and that actors cannot afford the financial risk of repeated defaults on budget caps that cover primarily high-cost medicines,” said Acemi, president of the main EPS association.

According to the union leader, without resolving this issue, it is not reasonable to think about changing the model proposed by the government. “Let’s solve the problem today, which is very important,” he adds. However, the executive remains committed to resubmitting the reform project, which will be presented in the Capitol next week. Despite meetings with various associations and unions, those who know the matter confirm that the administration

Ricardo Avila

Exclusive to EL TIEMPO

On the 10th: @ravilapinto