Minister of Health, during the debate on the health reform in the Seventh Committee of the Senate.
Photo: Mauricio Alvarado Lozada
The Ministry of Health published as a draft the third decree that adjusts the health system in Colombia. The document addresses a topic that is widely debated in the country: a tariff manual. The objective of the norm is to “establish the tariff system and replace the Tariff Regime Manual for the medical, surgical and hospital care of victims of traffic accidents, natural disasters, terrorist attacks and other catastrophic events defined by the Ministry of Health and Social Protection”, as well as the care of emergencies of another nature, if there is no agreement between the parties.
The tariff manual is a document that establishes the values and rates for medical services and procedures that may be provided to users of the health system. According to the justification of the decree, it is proposed to “sustain the flow of resources in order to attend to the health needs of the population in a timely and sufficient manner.” To update the manual, several regulations were considered that regulate how health service providers are registered and how services are enabled.
The document indicates that the update proposed for surgical and interventional, non-surgical procedures, hospitalization services and patient care transportation, had the contribution and participation of different actors in the system, among them, associations of health professionals, unions of institutions providing health services and unionized and non-unionized institutions, “which are considered suitable sources, without this meaning that the governing body of the SGSSS requires their endorsement to regulate the matter,” can be read in the draft of the decree .
Furthermore, the Ministry of Health It had historical information on the health services provided to the population affiliated with the EPS and other entities, “which constitutes an important source for updating the Rate Manual”. The update was also brought to the attention of the technical group of the Advisory Commission on Benefits, Costs, Rates and Operating Conditions of Health Insurancein order to receive your observations.
In its first articles, the document explains that the new tariff manual incorporates, among other criteria, the value of health procedures associated with fees of health professionals, supplies, use of equipment and others necessary for clinical practice. Everything provided in the document applies to Adres (the so-called health bank), insurers authorized to issue the SOAT, public and private health service providers and patient transfer companies.
For the provision of health services of another nature by the institutions providing health services, the draft decree states that “the rates agreed upon between the entities responsible for payment and the health service providers will be paid according to the agreements of wills concluded between the parties. However, these agreements will have to take the rates in this manual as a reference. In article 7, the draft specifies that the new rates must be implemented from the date of publication in cases of mandatory compliance and in others, within the following three months.
“Having a tariff manual has been a dream for several decades now. This has been built based on the expertise that we have already been able to acquire from international references. It has already been validated with different interest groups, public providers, associations, and human talent in health. This manual has considered several adjustments. Some very important ones have to do with the coding of the different services provided by hospitals, clinics, centers, health posts and others, and also incorporate developments of basic and medicalized care transfer, among others, trying to cover operating costs. and leaving a margin so that it can be reinvested in the qualification of human talent,” Luis Alberto Martínez, Vice Minister of Social Protection, explained a few weeks ago.
Martínez added that the manual contains updating components in each of the groups, for example, surgical procedures, interventions, which have to do with inpatient services, hospitalization, basic care transfer services, “and a very important one, which incorporates incentives that improve the accessibility of services in rural and dispersed rural areas, and the definition of pricing rules.” (Can see: If the health system is underfunded, where is the money going to come from?).
However, not everyone likes the idea of a tariff manual for the health system. To explain the fears with this measure, we must understand that in the health system there are several ways to contract services. EPSs can negotiate large service packages with hospitals and clinics, allowing them to obtain better rates. They can also contract through something called “pay per event,” where each procedure is paid separately. “In that sense, you pay, for example, for each cesarean section, which is more expensive,” explains Paul Rodríguez, economist and scholar of the Colombian health system. “What the Government proposes with a tariff manual is to pay everything per event.”
“We see it with SOAT. He SOAT It has fixed rates (which are updated from time to time). And it is very difficult to maintain the prices of technologies that are traded all the time in the market. The most tangible thing in the SOAT is this issue of ambulances that run looking for injured people because it pays very well. That’s the kind of problems that start to arise. So every procedure ends up being a good business in some areas and not in others,” explains the researcher.
