The reform launched by FOMAG is underway. The teachers’ health system may lose its prerogatives and end up being just another version of Law 100.

On December 30, while saying goodbye to the old year, the Board of Directors of the National Fund for Teachers’ Social Benefits – FOMAG, with the signature of Dr. Hernando Bayona, Vice Minister of Education, issued Agreement 05 of 2022.

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Bayona, an economist and former official of the Universidad de los Andes, once appointed in September of the previous year by the then Minister of Education Alejandro Gaviria, announced among his goals to carry out a “structural reform” of the teachers’ health system.

Agreement 05 modifies Agreement 09 of 2016 regarding the health care model and its financial structure, among other central points of the Special Health Regime to which teachers and their families are affiliated.

Educators, as well as Ecopetrol workers, members of the Police and the Military Forces, enjoy a model exempted from Law 100 and therefore without EPS and with different and broader health care conditions than those of the insurance regime established in 1993 for other Colombians.

Over the years, teachers organized in FECODE have defended their special health regime, although they have sometimes been forced to protest against the low quality of service provided by hospitals and other providers contracted to cover their health needs.

It is important to differentiate between the exempted regime of Law 100 in force for teachers, considered a precious asset for teachers, and the problems of administration and the low quality of care provided by the IPS contracted under this model, a situation that educators have repeatedly denounced. FECODE has defended the special regime but protested the precariousness of the care provided by some of the contracted health care providers.

Based on the aforementioned Agreement 05, since July 13, 2023 the “Public Invitation” (see link here), governed by the rules of private law (p.145) is underway with the purpose of “contracting entities that guarantee the provision of health services” and “the continuous improvement of the General System of Occupational Safety and Health” to FOMAG affiliates, “assuming and managing the health, operational and financial risk arising from the contract” (p.1).

Under this simple formulation, in a 340-page document, the conditions are established to materialize the structural reform announced by Vice-Minister Bayona, which converts the special health regime for teachers into one that adopts and adapts the guidelines, strategies and mechanisms of the health insurance system that characterize Law 100.

The reform of Agreement 05 renames the special regime, now called: Modelo de Atención Integral en Salud del Fondo de Prestaciones Sociales del Magisterio (MAISFPSM) and makes Integrated Health Risk Management (GIRS) the “transversal strategy” of all levels of care, “from prevention to palliation” (p. 52).

The new MAISFPSM is now governed by the Integrated Health Care Policy (PAIS) and the Model for Integrated Territorial Action (MAITE) (p. 50). Both the policy and the model were designed during the Santos and Duque governments by their Ministers of Health, Alejandro Gaviria and Fernando Ruiz. They were financed by the Inter-American Development Bank (IDB) with a loan of US$250 million.

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The PAIS policy and the MAITE model aim to facilitate, through Integrated Health Service Provider Networks (RIPSS) and Integrated Health Care Routes (RIAS), the EPSs’ technical management of Integrated Health Risk (GIRS). In the PAIS and MAITE, the EPS are the predominant actor. As will be the operator contracted for the teaching profession, which will act as the EPS, and also as the Labor Risks Administrator (ARL) (p. 236 and 237).

While the operator will have to manage the necessary health risk, “the public invitation” also describes in detail the different types of financial risk it will be responsible for: actuarial, credit, liquidity, capital market, market failure (p. 92 et seq.). In this way, the health care of teachers will be subject to the economic interests of the insurer.

The value of the contract, with a duration of 4 years, is for the not inconsiderable sum of more than 15 billion pesos (FIFTEEN BILLION ONE HUNDRED AND EIGHTY-EIGHT THOUSAND TWO HUNDRED AND TWENTY-FIVE MILLION NINE HUNDRED AND FORTY-SIX THOUSAND FIVE HUNDRED AND TWENTY-FIVE PESOS, $ 15,188,225,946,524) (p. 253).

The calculation of the Teachers’ Capitation Payment Unit (UPCM), made up of contributions from affiliates and contributions from the State, was modified in Agreement 05.

The UPCM was defined as the value of the UPC of the contributory regime (UPC-C) increased by 62.67% of this value, an increase that includes 2.79% for occupational risks and 59.88% for “those aspects inherent to the exception regime” (p.18). The increase in the UPCM opens the door to increases in the contribution of FOMAG affiliates.

What is at stake is the health of more than 900,000 people, including active teachers, pensioners and family members who are beneficiaries of the health regime, 400,000 of them, 45%, already present serious health problems and barriers to access services, “they are in remote, distant, rural and difficult to access geographic areas, they are over 75 years of age and are identified with diseases such as diabetes mellitus, hypertension, CKD, arthritis, cancer, hemophilia and HIV” (p.63).

It is undeniable the risk involved in the change in the nature of the special health regime for teachers, from being exempted from Law 100, to an insurance system standardized with the contributory regime of Law 100.

Health systems financing or on spilt breast milk