Health reform leaves EPSs in “legal limbo”, says expert
On the afternoon of February 13, and after months of expectation regarding the specific text of the proposed health reform, President Gustavo Petro and the Minister of Health, Carolina Corcho, filed in Congress the bill that will be submitted for discussion and voting.
We spoke about this issue with Claudia Vaca González, a professor at the National University of Colombia, who belongs to the think tank Medicines, Information and Power. Vaca González gave her first points of view on the text of the reform, and specified that a new reading is still needed, with which more details can be entered for further analysis.
You may be interested in: Stagflation in Colombia: the country could be entering one of the most frightening situations for economists
On the one hand, the professor was optimistic about the shift in the health system towards primary care. “The commitment to primary care is an agreement that exists from one end of the country to the other and from the political positions. It is perhaps the most important bet that is being made and almost all the content is focused on it”, she said.
According to the academic, primary care, which is explained in the document, refers to ensuring that all health procedures are organized around primary care centers, which would allow the service to be present in the various territories of the country.
Another point that constitutes a success for the expert is the proposal for labor formalization, which seeks to address the deterioration of working conditions and even the precariousness that health workers have been suffering. Although this is a very serious issue that has been going on for decades, it became particularly visible with the pandemic, which is why an important part of the health personnel view this aspect of the proposal with expectation and are in favor of it.
On the other hand, Vaca expressed his concerns regarding the financing of the model, the governance, the capacity to attend medium and high complexity treatments, and pointed out that there are expectations regarding the existence of the EPS and the transition to the new model.
Medium and high complexity treatments
By focusing on primary care, it is not clear how much capacity the new model will have to address the more complex health requirements of the population.
According to the academic, the text of the reform is not clear on how specialized care will be organized, nor how referrals to specialists or to hospitals that attend more complex procedures will be organized, in order to guarantee prompt and effective care.
In this regard, the professor points out that the text does not clearly explain how high cost and high complexity will be managed. Nor is it known how the technological pressure of new drugs, which are characterized by their very high cost, will be dealt with.
According to Claudia Vaca, the chapter “Drug policy” does not make “a strong commitment to solve perhaps one of the most serious problems that the Colombian health system has today -that of ‘ultra expensive’ drugs- and which other systems in the world also face”.
The limbo of the EPS
Professor Vaca points out that the bill does not contemplate the elimination of the EPSs, but that “in the new proposal they eliminate the EPSs as the backbone, both in the management of resources and in the management of the health of the populations and of the risk”.
Regarding the participation of the EPSs, Vaca explained that, although the text speaks of a transition that would lead in the future to the end of the EPSs and would avoid the constitution of new ones, it does not explicitly repeal the contents of laws 100 and 1122. As these are the laws that establish the health insurance model and the existence of the EPSs, what might happen with them remains in a certain “legal limbo”, said the professor.
You may also be interested in: Fenalco and ANDI agree on severe criticisms of labor reform
Therefore, there is no certainty as to how this transition would be carried out, nor is the assignment of functions explained: “it is said that they will affiliate the population, coordinate the care networks, establish the coordination of the care required in the network of services to be defined and they will also start with the availability of the territorial care centers, depending on the infrastructure they have”.
There remains the doubt, then, as to the ability of the new law to implement the new healthcare model without previously repealing the legal system that supports the current one, the academic continues.
Administration of the new model
Regarding the administration of resources, the proposal does not contemplate how much additional money would be required for the General Social Security Health System Resources Administrator (ADRES) to be able to take charge of activities that are currently in the hands of the EPSs, such as complex payments.
Nor does it contemplate the costs to be assumed by ADRES to develop the territorial capacities required to replace the tasks currently performed by the EPSs. Uncertainties such as these can be decisive both for the legitimacy of the government and for health care, explains the expert.
There is also a lack of clarity on health administration and especially on the articulation between health care networks and hospitals.
In this regard, the academic points out that “we do not have enough hospitals in certain regions. Today, referrals are made territorially to the municipal capital, to the nearest department or to the nearest hospital, but the line of authorizations or referrals is clear.
With the proposal this changes a bit; everything is centered on the primary care centers and it seems that it is transferred to the Health Secretariats”, explains Vaca Gonzalez, who warns that the lack of clarity could generate confusion, even among health administrative personnel, and put the lives of many people at risk.
Prepaid medicine and private insurance
The academic explains that the text of the reform explicitly states that it does not change the prepaid medicine or private insurance regimes, nor does it touch the special or exceptional regimes such as those of teachers, the Armed Forces, Ecopetrol and the Banco de la República.
“People with high incomes are already moving to prepaid medicine and private insurance, which are more expensive services but give them much more certainty”. With the above, it can be understood that “the promise of reducing inequities is possibly on paper concentrated in the most forgotten territories, but the inequities of the privileged remain untouched”.
In the event that an adequate transition is not achieved between the current healthcare model and the one that would be created, or that the uncertainty is maintained, healthcare businesses such as prepaid medicine and private insurers could be strengthened, the expert indicates.
In addition, the EPSs that have the knowledge and experience in the operation of these services could be converted into private insurance companies, so that people with the capacity to pay could move to these services.
