Death and illness, the sayings say, are two unavoidable stages of life. The first, sometimes, preceded the second. Equally inevitable is the possibility that in these times we will all become users of the health system. Which means that we are all potential and/or recurring patients, at different levels of complexity.
Thus, patients are the ones in the middle of the crisis that the health sector is experiencing in Colombia, which is reflected in the withdrawal requests in two months of three EPS, which total more than 7,550,000 affiliates: Compensar, Sura and Bolívar Salud.
Compensar – which requested total and voluntary liquidation – was the first to do so on April 5, followed by Sura – which requested progressive dismantling – on May 28, and the most recent was Bolívar Salud – which requested its total voluntary retirement – on May 5. June.
Given this, organizations such as the Colombian Federation of Rare Diseases or Patients Colombia have warned that this population is the most affected by all the movements in the sector. More with the uncertainty of what will happen to the members of these EPS and where they will end up to continue with their treatments, order their medications and make their appointments on time.
Where do EPS members who request their retirement go?
Since the health promotion entities have existed (with Law 100 of 1993), each time one left the system because it was liquidated (either due to mismanagement or bankruptcy), its members were transferred to others in the middle of a process led by the Ministry of Health and the Superintendency of Health.
However, now the panorama is different. These three EPS are not being liquidated, but are asking to withdraw because they cannot bear the financial burden of continuing to guarantee the attention of their users.
You may be interested in: Compensar EPS requests “total and voluntary” liquidation from the Health Superintendency.
Likewise, except Salud Total (4.7 million members), the vast majority of large and historical insurers are under the control of the Government – after forced intervention to administer -, such as Nueva EPS (10.8 million), Sanitas (5 .6 million), Famisanar (2.9 million) and Asmet Salud (1.8 million). While those that are not intervened or requesting withdrawal have a low number of members. As is the case of Mutual Ser (2.6 million), Cajacopi (1.4 million) and Capital Salud (1.1 million). Which leaves the question open: will they have the capacity to receive users in the millions?
“Actually, today there is little that patients can do, since the transfer options are becoming fewer and fewer and little by little we are going to be left in a system administered by the State, regardless of the EPS in which we are,” he said. Giovanni Jiménez, a health researcher at the Jorge Tadeo Lozano University, told EL COLOMBIANO.
So what will happen to the patients?
With this panorama, practically the answer is to wait, both for the users of the EPS who are asking to leave the system, and for those of those who are intervened.
In the words of Jiménez, “in the case of the EPS that voluntarily withdraw and those liquidated, the uncertainty with the continuity of care, especially for chronic and high-cost patients, is high” and he explained that in light of this “they will have to reorient their care processes in the EPS to which they are transferred.”
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On the other hand, he explained that in the case of the users of the intervened EPS “the uncertainty is not so much, as long as the interveners do good management, but if this is not the case, they may suffer problems in meeting their needs in health”.
However, in the case of Compensar, Sura and Salud Bolívar users, the Health Superintendency has a margin of 65 business days to approve their withdrawal, as well as their subsequent dismantling, to continue demanding health services, since by law The EPS have to guarantee care until the last day you are in the insurance sector.
And from then on, wait where they are transferred to and that the transition and subsequent operation are trauma-free. Even so, researcher Jiménez notes that “the health reform is being carried out through pressure, cornering and decree.”
Why do they ask to leave the health system?
The short answer: due to lack of money. The long one: due to a financial crisis of the system, which has its origin in at least three aspects. Due to the insufficiency of the Capitation Payment Unit (UPC), which is the money that the EPS must make to pay so that their members are treated when they go to the doctor; for a Basic Health Plan (PBS) – which are all the health services and technologies to which we all have the right – which has increased over the years and became a market list; and due to a demographic issue, which has to do with the aging of the country, which leads to an increase in the demand for health services.
In the case of Compensar (requested its total and voluntary withdrawal) and Sura (requested progressive dismantling) they explained that this crisis took them to the financial limit, which was added to the Government’s refusal to review the sufficiency of the UPC and raise it to this year.
While, in the press release they published, Salud Bolívar (50,000 members) did not explain the reasons why they requested their total voluntary withdrawal. Even so, EL COLOMBIANO learned that it was a preventive measure, since they did not suffer from financial or accident problems (events presented that are subject to medical coverage).
In that sense, prevention revolved around the fact that, since they were not intervened or with the problems of Compensar and Sura, they could be potential recipients of the population who would be left without EPS if they approve their withdrawal. And going from managing the risk and health care of members who number in the tens of thousands to those in the millions is, to say the least, chaotic.
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