An analysis concluded that the deficit of the Colombian health system for the period 2020-2023 it would be $16 billion and not the $11.4 initially calculated.
The study by the Sectorial research firm readjusted the financial data of the sector after It was learned that Nueva EPS had not reported liabilities of $5.5 billion.
It is worth mentioning that recently the Superintendent of Health, Luis Carlos Leal, shared the first findings after the intervention in Nueva EPS and Sanitas. Although an official report has not yet been issued, Leal indicated that Nueva EPS would have “hidden” invoices, accumulating a debt of nearly $5.7 billion with IPS since 2019.
Thus, according to the document, for every $100 that entered the system in 2023, $109.5 was spent and not $105, as had been proposed when the reality of the largest EPS in the country was unknown.
“The imbalance that was being omitted in Nueva EPS, to which one in five Colombians is affiliated, significantly alters the entire average of the health system,” comments Alejandro Escobar, strategic manager of Sectorial.co.
According to the analyst, the company’s accident rate in 2023 – its relationship between costs and income – was 98.6% before the discovery of the unreported costs, but with the new scenario this percentage shoots up to 119%.
Reasons for the deficit of the health system
To adequately correct the financial situation, the Capitation Payment Unit (UPC), that is, the money that the State allocates for each member, “should have increased by 20% instead of 12.01% (current), and maximum budgets by 10.4%,” according to Escobar.
According to the analysis, the gap in the financing of the Colombian health system between 2020 and 2023 responds mainly to the debts of the Punto Final Agreement, under the government of former president Iván Duque ($1.2 billion) and the difference between income and costs of the period ($14.7 billion).
“The point that has impacted is the difference between the UPC transfers and the transfer of the maximum budgets versus the costs that both their maximum budgets and the provision of the associated services have,” Escobar explained in conversations with Valora Analitik.
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Likewise, the report estimates that, in 2024, the system will need $99.6 billion for its sustainability, however, only $89.7 billion was forecast. For this calculation, the increase in accidents, the new inclusions in the Health Benefits Plan (PBS) and the increase in inflation are taken into account.
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Under current conditions, the report says that the system will face a defunding in 2024 of $9.9 billion and by not having corrected the estimated historical shortfalls, the total shortfall would amount to $26.5 billion.
Sectorial.co notes that, at the end of 2023, The EPS were left with liquid resources of $7.5 billion –the so-called liquid technical reserves– that they will have to use to cover part of the cash shortage in 2024 of $9.9 trillion.
“If the problem is not corrected, the system would run out of resources in September 2024, that money will not be enough. So in September of this year we will probably face a blackout,” Escobar concludes.
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The near future of the Colombian health system
In a conversation with Analitik is valued by the Sectorial manager and expert on the subject, Alejandro Escobar, discussed the future of the financial system and the interventions made by the Petro government, as well as the prospects for the health sector. This answered:
How will the interventions affect the health system?
From our perspective, the interventions in Sanitas and Nueva EPS were hasty. We consider that the acceleration of these processes is an attempt by the government to control the financial resources of the health system. Currently, with the seven interventions carried out, the government already controls more than 53% of the system’s financial resources and more than 55% of the affiliated population.
Regarding interventions, we hope that this process will give good results and allow the companies to recover. The worst thing would be if these interventions culminated in liquidations, which would be the most unfavorable outcome.
Will the Adres figure as the sole payer work?
The proposed health reform included assigning the Administrator of the Resources of the General Social Security Health System (Adres) as a function to be a single payer.
This means that Adres would have full control of payments, directly managing financial resources. Although the reform was not approved, Adres already has the capacity to make direct transfers to the entities that the companies indicate. If these companies are controlled by the State, a situation similar to the original health reform proposal would be taking place, centralizing financial control in the hands of the government.
What could be the near future of health in Colombia?
We must solve the financial problem and cover the cash deficit so that the system can operate properly. Only then can we implement measures associated with prevention, protection and territoriality, which are key aspects of the reform.
It is not just about establishing a single payer, the priority is to solve the serious financial problem that we currently face in order to make progress in these areas.
