Health reform faces tough challenges, in a context of uncertainty about the future of the EPS and the way in which the health system crisis will be resolved.

In recent years, Colombia has witnessed a series of challenges in its health system, including access barriers, problems of care by Health Service Provider Institutions (IPS), financial limitations on the part of the Health Promoting Entities (EPS), and even the challenges presented by the Covid-19 pandemic.

This system, which at the time was designed to guarantee quality health care to all citizens, is today at a crossroads that requires the immediate attention and action of the National Government, since, in addition to the health reform currently underway in Congress, other problems in health care have recently been identified.

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The underlying causes of this situation are complex in nature and are rooted in a number of structural challenges inherent to the Colombian health system.

However, they can be summarized in three fundamental aspects that the Colombian health system must address: insufficient financing, unequal distribution of disease burdens and delayed government payments. These circumstances, although accumulated over the years, are reaching a critical point that demands an immediate response.

It is in this context that EPS Sura, Sanitas and Compensar, three of the largest EPSs in the country, have issued an urgent appeal through a letter sent to the Ministry of Health on July 27, 2023.

These EPSs, which together affiliate more than 13 million Colombians, warn about the seriousness of the difficulty they face to continue operating beyond September.

They warn that the financial indicators are at risk of not being met, which could result in the suspension of basic medical care for a significant number of people.

Faced with this crossroads, it is imperative that the National Government adopt concrete measures to avoid an even more serious crisis in the health system, measures that must be participatory and built through the consensus of different actors.

In this sense, it is necessary to make an urgent review of the Capitation Payment Unit (UPC), which is the money that the system allocates for the care of each Colombian.

According to several experts in health economics, this is insufficient to attend to the population, mainly due to the advances in medical technology and also to the increase in chronic diseases, a situation that makes the care process more expensive.

Therefore, a realistic and adequate increase in the UPC would make it possible to cover the costs of the Basic Benefits Plan and would alleviate the financial pressure that plagues the EPSs.

At the same time, speeding up the process of payment of accumulated debts, including those arising from the pandemic, would inject liquidity into the system and enable EPSs to meet their financial commitments.

In this struggle to preserve the health system, collaboration between the public and private sector emerges as a valuable alternative, since, through strategic alliances, it is possible to foster an environment conducive to the generation of innovative solutions that optimize the operational and financial efficiency of the EPS.

At the same time, the implementation of rigorous audits and anti-corruption measures is essential to guarantee transparency and the proper use of resources allocated to health.

On the other hand, in a context where a health reform has not yet achieved approval in Congress due to the uncertainty surrounding the elimination of the EPS, but also due to other factors that are being discussed, it is valid to question the viability of this request to have this governmental support, since, since the arrival of the new government, the direct intention of eliminating the EPS has been perceived.

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However, the urgency of the current crisis and its roots in structural problems opens the door to consider intermediate solutions that do not necessarily entail the total elimination of the EPSs, this while the health reform is being resolved and an eventual transition takes place in case it is approved.

This call for help launched by EPS Sura, Sanitas and Compensar cannot be overlooked. These entities recognize that the financial crisis has been brewing for years, but understand that it is up to the current administration to find solutions to avoid the interruption of the provision of basic medical care for millions of Colombians.

The consequences of not acting promptly and effectively could be devastating. Among them, the following stand out:

• Limited access to medical care: The population could face difficulties in accessing basic health services due to lack of funding and resources.
• Collapse of medical care: The 13 million enrollees would face a potential lack of access to basic medical care, which could have a negative impact on the health and well-being of these individuals.
• Pressure on other providers: The paralysis of these EPSs could increase the burden on public and private hospitals and clinics, potentially leading to a saturation of the healthcare system.
• Economic impact: The closure of these EPSs would affect the 34,000 direct employees and their families, which could have a negative impact on the local economy and workforce.
• Unemployment and labor crisis: The closure of EPSs could result in the loss of jobs for the personnel of these entities, which would have a negative impact on the local economy.
• Social unrest and discontent: Lack of access to medical care and problems in the health system could generate discontent and unrest among the population.
• Increased complications of some diseases: Disruption of EPS operations nationwide could have a detrimental effect on the control of chronic diseases such as diabetes or hypertension.

Lack of access to medicines, treatments and adequate medical follow-up could lead to an increase in the complications of these diseases, resulting in a deterioration in the health of patients and a greater burden on the health system in the long term.

Preventive care and proper management of chronic diseases could be compromised, affecting patients’ quality of life and leading to increased health care costs in the future.

Therefore, it is essential that the Government and the EPSs work collaboratively and quickly to find solutions that avoid these consequences and guarantee the continuity of medical care for all affiliated Colombians.

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