Health reform still does not solve drug prices or system finances, warn UNAL experts

Last semester’s race for the approval of the health reform left several reflections on the problem of access to health care throughout the Colombian territory, the complexities of eliminating the EPSs from the health system and the challenges in terms of medicines, among many other elements that make up the health system in Colombia.

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The Minister of Health, Guillermo Alfonso Jaramillo, said that there is consensus to reprocess the health reform with patient organizations, the Health Promoting Entities (EPS) and the community. However, he stressed that there is a lack of political agreement to take the bill back to the Congress of the Republic.

In view of this situation, the Centro de Pensamiento Medicamentos, Información y Poder of the Universidad Nacional de Colombia (UNAL) identified the successes, problems and opportunities of the bill, in view of the new health reform procedure.

Positive aspects: flowers for health reform

The Think Tank of the National University highlights as one of the main positive aspects of this bill the territorial emphasis on primary care, as well as the effort to reduce inequalities.

With the public presentation and the procedure in the Congress of the Republic, the health reform reopened the debate on the enormous inequities in health throughout the country, and highlighted the gap that exists between rural and urban areas.

In addition to making the problem visible to public opinion, so well known by a large part of the country’s population, the National Government’s health reform insists on primary care and on ensuring the intervention of the health system throughout the national territory with the aim of reducing inequality, strengthening the competencies and capacities of the territorial health secretariats.

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Financing of the health system, among the main challenges

Health care reform is not all flowers. The Think Tank of the National University detailed three problematic aspects of the formulation of the reform.

In the first scenario, the Think Tank highlighted the pronouncements of the Vice President of Pharmaceutical Policy of the Colombian Medical Federation, Dr. Óscar Andia, who highlighted the unwillingness of the authors of the reform to listen to the health sectors that see this process as a great opportunity to implement the changes that the system needs.

In addition, Dr. Andia expressed his concern about the “deterioration inherited from past administrations in various elements such as the information system and the elimination of competition in biotechnology”, explained the UNAL Think Tank.

Andia also pointed out the power of the EPSs as a negative aspect. According to him, these entities claimed a debt of $5 billion from the previous government, while the current government doubled the value, assuring that the debt is $10 billion.

The Center also referred to the financial problems of the health system, which have become evident in recent years, with the closure of several EPSs and the lack of health protection for thousands of citizens. In view of this, the Center pointed out that experts from the organization Así Vamos en Salud stated that the financial problems of the system set alarm bells ringing and represent major threats to the provision of services.

What still needs to be worked on in the health reform

With the health reform, President Petro’s government is missing the opportunity to go further in the area of health, according to the UNAL think tank, as it would be worthwhile to include policies on medicines and health technology, as well as to strengthen health insurance for the female and LGBTIQ+ population.

The National Government also has the opportunity to promote a “progressive patent system” that has the protection of public health at its core, said the Center. To this end, it should include the international nonproprietary name in all pharmaceutical patent applications; involve the Ministry of Health in patent applications; and establish more rigorous criteria in patent guidelines for drugs and biotherapeutics, it said.

Likewise, the Government should adjust and implement the regulation of drug prices, with the purpose of establishing them based on the therapeutic value before granting sanitary registrations (Article 72. Law 1753 of 2015). Another point highlighted by the UNAL Think Tank is to advance in the implementation of agile mechanisms to “declare the public interest in patents of essential health technologies during emergencies”. It also recommends adopting an active stance in the WHO debate on the Pandemics Treaty, to ensure that negotiations on intellectual property support public health in these contexts.

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