a new tax? / Joint

In just over a year and a half, the incessant messages of dissolution of the current Healthcare system coming from the Republic Presidentof the two ministers of the Health portfolio and of the two Health superintendents so far this four-year periodcreated between the Colombian population and the agents that operate within the system, an anxiety of magnitude such as had not been seen in the last half century of national life.

And that concern has been confirmed with the recent and eventful launch of the regime’s new operation. health exemption for 800,000 public teachers, which has exposed improvisation, unfulfilled promises, and an evident failure despite the unrestricted – and irresponsible – support of the teachers’ union, and the fact that the minister of health maintained that this would be the pilot to demonstrate the great benefits of the reform that so much The government and the political group that supports it are promoting it frantically. Also, The interventions of the National Health Superintendency to the EPS are more like hostile takeovers than administrative improvement processes, resulting in more than 25 million members today depending on the decisions of a few discretionally appointed officials. In addition, two of the most serious EPS requested to end their operation before the definancing of the Capitation Payment Unit or UPC.

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While all that happens, The medical needs of 52 million people are a pressing reality, true. Regardless of the ideological whims of irresponsible politicians, people need medications, hospital and emergency care, surgical procedures, consultations, therapies, diagnostic tests, vaccines and prevention programs every day; Thus, faced with a Health System in crisis and suffering from the already palpable delays in the provision of medical services, Colombians have to begin to reach into their frayed pockets to pay directly for medical services that, with increasing inefficiency, supplies a Health System in disintegration.

What is Out-of-Pocket Health Expenditure (GBS)? In simple terms, It is the total expenditure that a family makes on its own to pay for medical services, medicines and other health needs not covered by the State’s health and social security services.. In other words, the increase in the GBS takes money away from covering other basic needs of a family, such as food, education, housing, and plunders their fragile economy in many cases.

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While the average of Out-of-pocket health spending in Latin America is 42.7% percent of total health spendingaccording to a study by the ICESI University In Colombia that expense is 20.6%, half; Explained another way, it means for every peso that a Colombian spends on health, the State invests four pesos, 20%. And countries like Brazil have a GBS of 43.9%, Mexico 40%, Chile 34.7% and Venezuela 33.8%. Therefore, The majority of Latin Americans have to spend more out of their own pocket than Colombians and only Argentina had a lower GBS (Data from ICESI University).

From a health systems evaluation perspective, why is it important to evaluate GBS behavior? Because if families have to spend more out of pocket to cover health needs, it means that their System is probably less efficient or provides them less or has lower coverage.. It is understood then that, if families in Colombia have a low Out-of-Pocket Expenditure on Health compared to other countries in the region, there must be something good about the current Colombian System. But they still want to destroy it, they are destroying it.

So families, faced with the great uncertainty created within the Mandatory Health Planand, since they will not be able to be covered with the EPS Complementary Plans because they are disappearing, they have begun to look for alternatives to cover their risks through Prepaid Medicine Plans or more expensive Private Health Policies, and thus ensure the medical services they receive today without paying more, but due to the uncertainty created, they fear that they will no longer receive more or that they will receive incomplete or poor quality.

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These private plans have large variations in cost depending on their coverage, with prices between $200,000 and $1,200,000 per member/month. Although this is good news for insurers who will see their portfolios grow, It does not seem so for many families who have to invest in private insurance when they had not contemplated it.

We will have to start buying more medications in the commercial pharmacy channel, which usually sells at a higher price, and in many cases we will have to seek specialized medical care in clinics and private offices due to the inability of services intervened by Supersalud or poorly planned or administered. under political influence as already seen. Of course, it is understood that families with higher incomes will be those who can afford more private medical services.leaving the population with fewer resources at the mercy of what the system can provide them, whether the current one that is in a critical state or a new and ideal one as they want to impose, which, if it works, will take several years to operate efficiently. .

So we can count from now on that families’ Out-of-Pocket Health Spending will grow steadily for as long as the crisis lasts. If the System today costs, incorrectly counted, $100 billion and Out-of-Pocket Spending on Health rises to the levels of countries like Venezuela, Mexico, or Brazil, for families it will mean an additional expense of between $15 and $25 billion, something like a kind of ‘new tax’ that Colombian households will have to pay from now on.

FRANCISCO DE PAULA GÓMEZ
Expert in Public Health and Social Security.