At a critical moment for the Colombian health system, EPS Sura has taken a step forward to face the structural and conjunctural crisis that has put the country in check. The insurance entity highlighted that health, being a fundamental right, faces severe challenges that threaten its sustainability and equity.
According to EPS SURA, the current crisis derives from multiple factors, including the liquidation of several EPS, changing epidemiological conditions, an aging population and a low birth rate, in addition to the prevailing need to integrate new technologies. These factors, combined with a limited budget and an increase in the use of health services, are straining the system’s finances more than ever.
In this way, the company highlighted that the insufficiency of the Capitation Payment Unit (UPC) and the lack of recognition of adequate funds are the main financial concerns. “The insufficiency of maximum Budgets: an issue for which in recent weeks only 50% of the value owed for the years 2022 and 2023 has been recognized. The change in the UPC allocation base in 2024, in which recognizes 2% of UPC for the population over 50 years of age, as was granted in 2023”, Sura highlighted.
Additionally, rate negotiations for 2024 have presented significant challenges, along with the proposal to allocate 5% of the UPC for territorial equipment, which could further compromise available resources.
Faced with this situation, EPS SURA has actively participated in work sessions with the National Government, seeking to transform the EPS into Health and Life Managers. These discussions have explored how the proposed changes could improve healthcare management and offer more sustainable solutions.
“This is a conversation among many others that must take place and that is focused on the role that the EPS would assume within the new system and that therefore makes our participation in it relevant,” Sura pointed out.
He also added: “We are aware that these proposed agreements on the role of the EPS are only part of what our system needs, and therefore, at EPS SURA we consider it essential to continue the conversation on other structural issues and take into account the contributions of the other actors in the system, especially patients, health personnel, health service providers, academia, proposals from congressmen and other public entities such as observers and representatives of citizens.”
EPS SURA proposals to improve the health system
In this way, EPS SURA proposes a series of additional measures to improve the health system, which include increasing transparency through the integration of information systems and the creation of a system of indicators to evaluate the performance of all actors in the system.
Transparency in the management of the health system:
To ensure the proper functioning of the system, it is essential to implement interoperable information systems that integrate clinical, epidemiological, administrative and transactional data. This will facilitate informed decision-making, surveillance and control, increasing transparency and supervision.
EPS Sura suggests the creation of a system of indicators that, through economic incentives or sanctions, evaluates the fulfillment of objectives by the various actors such as the EPS, IPS and Territorial Entities. In addition, it proposes to adjust the Capitation Payment Unit (UPC) according to the risk of each population and incorporate new sources of financing, such as healthy taxes and works for taxes, to improve infrastructure in rural areas and promote public-private alliances.
Improved access to the health system:
According to the EPS, it is crucial to increase the availability and capacity of Human Talent in health, both in urban and rural areas. In addition, it is necessary to strengthen health infrastructure to ensure adequate care, improving connectivity and access in all territories. It must be ensured that operating models allow easy access for users and agile management of services by providers. This includes the simplification or elimination of procedures and the consideration of subsidies in specific territories where they are necessary.
Strengthening governance and stewardship of the system:
Health management must transcend government boundaries and include citizen participation and intersectoral representation. EPS Sura denotes the importance of reactivating the National Health Council as a collegiate entity that supports the Ministry of Health and Social Protection in decision-making. This Council should include representatives from various government sectors and a committee of independent experts. Furthermore, their work must be complemented by an administrative structure that includes support commissions for planning, development of human talent and regulation of the sector.
Comprehensive health risk management:
It is vital to ensure that health services are managed territorially, articulating individual and collective interventions. The development of a preventive public health model at the national level is suggested that addresses social determinants such as nutrition, access to drinking water and clean air, in order to prevent diseases and reduce mortality. It is also proposed that financial risk management be the exclusive responsibility of the State.
“At EPS SURA we want to reiterate that we continue working for the purpose that inspires us: taking care of life. In this context, we are willing to continue contributing from the technical knowledge and experience that we have obtained for more than 30 years; “Listening to the different actors and presenting our proposals to all of them, with the purpose of moving together towards a more sustainable health system,” EPS Sura stated.
