After the work sessions with the EPSthe president, Gustavo Petro, confirmed in his X account that they agreed on the criteria for transforming these entities into health managers, their role and the responsibilities they would have within the system.
But the doubts about this whole matter not only focus on what a health manager is, but also on what functions she assumes when her role changes and what will happen to the EPS that do not take advantage of the new system.
Article 24 of the bill that was agreed upon with the EPS and that has been put for citizens’ consideration, establishes that health and life managers are entities that can be public, private or mixed that arise from the transformation of the EPS, and they are assigned a series of functions basically aimed at comprehensive health and operational risk management in each of the assigned territories.
In the legal framework, these health managers will have 25 functions established in the same billrelated to health risk management actions, the coordination of reference and counter-reference systems, the establishment of intervention plans and articulation of services for health demands, among others.
Working with Caps
The first nerve block has to do with the Primary Health Care Centers, Caps, with functions such as leading actions to identify, segment and analyze health risks; organization and formation of service networks for the territories; manage health risk in coordination with the Caps; establish intervention plans and articulate the execution of operational management to respond to demand; manage a reference and counter-reference system in coordination with departmental secretaries, among others.
Optimize financial resources
Another block of functions has to do with resources, since health managers must deliver periodic reports on the operation of the networks; contribute to the efficient, rational and optimal use of financial resources; carry out a comprehensive audit of quality, medical accounts and concurrent health service benefits; validate the billing of the complementary component; carry out accountability of their activities with periodicity; as well as carry out the management for the payment of financial benefits.
Conditions to be a manager
Within 60 business days following the issuance of the regulations on the qualification and authorization of health and life managers, the EPS authorized to operate in the current regimes, and that meet the requirements to transform, must express in writing to the Ministry of Health and Supersalud that their intention to take advantage of said transition or not.
Although this consensus was achieved among delegates of the Presidency of the Republic and the Ministry of Health with Acemi, representing Nueva EPS, Salud Total, EPS Sura and Compensar; as well as Gestarsalud, on behalf of Mutualser and Coosalud, The project proposed two possible scenarios; The first, if the EPS wishes to transform itself, it must present the qualification project as a health and life manager; and in the second, if you are not interested, you must present your voluntary retirement plan. If you do not manifest either of the two, the withdrawal will begin immediately.
In the first case, the EPS have to present a cleanup plan for all liabilities backed by payment agreements with their creditors, or financial guarantees, complying within a period that does not exceed 48 months from the approval of Supersalud. If it is not fulfilled, it will enter the liquidation process.
For the second case, “the health promoting entities will have to present a reorganization plan that contemplates the payment of the entire liability in a time that may not exceed 48 months counted from the filing of the voluntary retirement plan or upon expiration of the 60 days provided for in this article,” says the reform project.
The project will recognize health and life management entities with 5% of the value of the Capitation Payment Unit assigned to finance health care. If you do not meet the established management standards, you will receive up to 30% less of your income in remuneration and if this happens a second time, you will be subject to a special supervision measure.
They may also receive up to 3% of the value of the UPC assigned to finance the health care of the population whose comprehensive care the manager participates in.
What do the experts say?
Jesús Albrey González, president of the Medical Law Bar Association, said that, “in order to establish the figure and change the insurance model, a legal reform must necessarily be carried out; In fact, what has happened is that the EPS and the Government have apparently agreed on a draft article concentrated in 47 articles, in which the EPS would be transformed into hybrid health managers.”
Paúl Rodríguez, professor at the Universidad del Rosario, explained that “the project has a ‘strange’ role in itself, which is to audit accounts, since it is like a tax auditor specialized in the health sector, which does not have a responsibility. about the expense.
