Former Minister of Health and current Dean of De Central University, Jimmy AriasHe expressed his main concerns about the project to health reform which is currently being approved in the Congress of the Republic, it is clear to him that this initiative is dividing the existing system into parts.
In a conversation with Infobae, Arias emphasized that this fix ends with the solid core of insurance. “We have two-tier insurance in the country, there is reinsurance by the state, because it’s a general system that sometimes works and sometimes doesn’t, it works during coronavirus, I should say, but insurance on average is what EPS“.
Arias explained, “The basis is based on what they call economic insurance which is that EPS has a compulsory health plan and also some benefits and some payments and if that breaks down and the current EPS fails to manage the economic risks, then it will not work as well. To manage the other risks, which are the same health risks, Which is with every patient, other risks I call operational, but economic risks are completely removed in the proposal to EPS and passed into the hands of TitleSo you will see the money as long as Adres has a budget, it will all run out, because no one will do the economic control of the expenses, when the EPS function is gone.
Arias stressed that this leads to a second point, which is that “the state will take economic risks because in the end the state will have to respond, and it will force it to have the kind of technical reserves that insurance companies have today, and I don’t see where, because we are talking about billions of pesos annually.”
The former minister outlined a third point on how to break the continuum of care. Because they consider Primary care centers (CAP) is the beginning, but there is a gap in CAP at the next levels, because they may be taken care of, but there is no continuity in care, as is the case today, where there is intermediate care and then very complex care. This is completely broken and this is very dangerous. Primary care is the gateway to even the most complex care, but there has to be a continuum from basic to complex and this will not be the case.”
Another concern is that it costs a lot more to fix than you think,” not only because you have to build and staff a lot of infrastructure in remote areas, but because there are costs associated with setting up a new system and it’s not accounted for. Ministry of Finance I have made calculations of 80 to 90 trillion, but this could go much further, not to mention that there would be more inefficiency,” he said.
“Another point of concern is the number of new actors that have been included in the management of the system, which will lead to much stronger complexity and more chaos,” the Rector of Central University stressed.
For him, this last point would lead to another danger: even greater corruption. “Not only because part of the management will take place at the municipal level, but because supervision will be very difficult. On the other hand, when the role of EPS, which is the controller of many things, disappears, there will be unbridled spending at the primary level and at all levels, which may lead to to increase corruption.
Arias believes that the transition will be very difficult because it involves moving from one paradigm to a completely different one. “At that time, I think there will be a lot of conflict and uncertainty and many institutions will disappear and people will not learn to manage the new system, so a two-year transition, plus a minimum of six months that it takes to implement, will create, in my opinion, extreme chaos.”
Jaime Arias stressed that he is concerned that the discussion of reform is moving through the political side and not through technical arguments.
Referring to change Minister of Healththat “Guillermo Jaramillo He has more experience in parliamentary administration, in fact he was the mayor, and the Minister of Health, in this sense things can improve a bit, but what does not change is the government’s view of the system and the role of insurance companies. On the contrary, the current minister is more strict, and the previous minister was more irritable, and she did not know the system, and I do not think that the current one knows it internally, but he lived in it, as he was a doctor for it. Many years in Bucaramanga and Stockholm, I think he knows more about the system than the minister, but I don’t think he knows the technical and economic details of it. In addition, he is convinced, like President Petro, that this system must be changed to a general one.
However, it was pointed out that “Health systems around the world are dynamic and must be modified, and the system in Colombia needs adjustments, but people think that changes are legislative, but this is not the case, most of the changes are made within the system itself, the doctors themselves, and the EPS , and IPS, as well as government institutions, these changes will always be needed.”
“This is a purely political issue, it’s not whether reform is good or bad, what matters here is the political game, first the government is trying to win over individual parliamentarians, even breaking party guidelines, and many parliamentarians are playing into that. They have their prebends. I am surprised to see Liberal parties, conservatives and others take a stand, they pause, they give in easily, but this time it may not happen for the following reason: This can be strongly influenced by the politicians who agree with this and in government in particular.”
“Suppose the reform is approved, I think it will result in chaos, the institutions will take over it in the beginning, but within a year it will already have an effect on patients and the repercussions will be very severe and it will fade away. Going back to the government, this is not enough to have an impact in the next regional elections But in the next presidential election, it will be very difficult for him Petroleum government Stay in power in the next elections because there will be a national revolution. Former Minister Arias concluded his speech by saying, “If the government is not approved, it will be responsible for defaming what is there, it will be lost with face and seal.”
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