According to data from portfolio study number 51 of the Colombian Association of Hospitals and Clinics (ACHC), the debt with 221 hospital institutions that report in the study went from 16.09 billion pesos in June 2023 to 16.8 billion in December of the same year, which represents an increase of close to 705 billion pesos and 4.38% in the amount of the portfolio. The concentration of the portfolio that is in arrears (greater than 60 days) reached 54%.
According to the study, The EPS of the Contributory Regime concentrate a little more than 50% of the total debt, which corresponds to nearly 8.4 trillion pesos, followed by the EPS of the Subsidized Regime, which concentrates around 23.2% of the total debt. , that is, about 3.8 billion pesos.
In third place are the debtors grouped in the State category, which account for approximately 8.8% of the total debt. And finally, the Soat insurers, which account for 3%, the companies that offer Complementary Plans and Prepaid Medicine, 2%; and the Occupational Risk Insurers, 0.3% of the total debt.
EPS of the contributory regime: New EPS main debtor
The total volume of debt for this period of the EPS of the Contributory Regime amounted to approximately 8.4 trillion pesos, with a delinquency of 52.2 percent.
81.1% of this debt, which corresponds to approximately 6.8 trillion, is held by 13 EPS that are in operation and 18.9%, which represents 1.6 trillion pesos, is owned by 16 EPS that have been liquidated whose portfolio is 100% in default.
Nueva EPS has nearly ten million members in the contributory and subsidized regimes.
Photo:Luis Lizarazo
It was observed that the list of main debtors in this regime with a cut-off date of December 2023 is headed by the Nueva EPS, with approximately 2.8 trillion pesos and a default of 44.7%.
Next is EPS Sanitas with a debt of 985.9 billion pesos and a default rate of 43.3%. Next is EPS Sura with a total debt of approximately 596.3 billion pesos and a default rate of 26.7%.
On the other hand, regarding the EPS of the Contributory Regime that present a lower concentration of portfolio in arrears, it was evident that Compensar is the one with the lowest percentage of arrears with 22.3%. Then there are Salud Mía and Aliansalud with a concentration of non-performing loans of 24.7% and 24.8% respectively, and Sura, which has a percentage of loans greater than 60 days of 26.7%.
EPS of the subsidized regime (EPS-S): Savia Salud, main debtor
The total volume of debt for this period of the EPS of the Subsidized Regime amounted to 3.8 trillion pesos, with a default rate of 63.7%. The debt of this regime is made up of approximately 71.7%, approximately 2.8 trillion pesos, of debt from 17 active EPS and 28.3%, approximately 1.1 trillion pesos corresponding to 34 EPS that were liquidated. or merged.
Regarding the debt that these entities have, it is observed that the main debtor is Savia Salud with approximately 561.5 billion pesos and a default of 38.9%. The following EPS with a higher volume of total debt as of December 2023 are Emssanar with 545.9 billion pesos and arrears of 58.3%, Asmet Salud with 387.9 billion pesos and arrears of 61.7% respectively. and Nueva EPS that owes 265.9 billion pesos, with arrears of 51.5%.
Regarding the EPS-S that present a better performance of non-performing loans, it is observed that Capital Salud (23.2%) and Mutual Ser (23.9%) are the ones with the lowest concentration.
Liquidated EPS debts
In total, the liquidated EPS have left debts to the ACHC lending sector of approximately 2.7 trillion pesos. Regarding the EPS of the Contributory Regime, close to 1.6 billion pesos are reported, corresponding to 16 entities, the most relevant due to their debt volume: Medimás with 573.7 billion pesos, Coomeva with a portfolio of 457.2 billion pesos and Cafesalud with 328.4 billion pesos.
Cafesalud is one of the main debtors among the liquidated EPS.
Photo:EL TIEMPO Archive
In the case of the EPS of the Subsidized Regime that were liquidated, approximately 1.1 trillion pesos are reported as debt corresponding to 35 entities, the most relevant due to their total volume: Ecoopsos with 178.7 billion pesos; Salud Vida owes 126.9 billion pesos and Comfamiliar Huila owes 122.7 billion pesos.
Main debtors
When ordering the entities with the largest volume of portfolio in arrears, the Nueva EPS is the largest debtor that the reporting providers have, accumulating a total debt in the two regimes in which it operates of 3.1 billion pesos and a portfolio in arrears of 1 .4 billion pesos, which represents a concentration of its non-performing portfolio of 45.3%.
In second and third place are the liquidated Medimás with a debt of 669.7 billion pesos and Coomeva with 457.3 billion pesos, both with 100% of this portfolio in default. Then there is EPS Sanitas, whose total debt amounts to 985.9 billion pesos and its portfolio in arrears to 427.2 billion pesos, which is equivalent to 43.3% of its total debt.
In fifth place is the liquidated EPS Cafesalud EPS, with a total portfolio of 360 billion pesos, with 100% default due to being in the liquidation process. In sixth place is Coosalud (both regimes) with a total debt of 650.7 billion pesos and a concentration of non-performing loans of 53%, which is equivalent to 345 billion pesos. Next is the Emssanar EPS of the Subsidized Regime, with debts of 545.9 billion pesos and a defaulted portfolio of 318.2 billion pesos.
In eighth place is the joint debt that Aadres has (due to Soat claims) and the defunct Fosyga, for a total value of 419 billion pesos and a concentration of defaulted portfolio of 75.5% (316. 4 billion pesos). Then there is Famisanar, with a total debt of 526.6 billion pesos and 271.8 billion pesos in default and Asmet Salud with a total debt of 387.9 billion and 239.4 billion in default. pesos.
In total, these 10 entities have a total debt of 8.15 trillion pesos, which represents 48.5% of the total debt that was recorded in this study, and a delinquent portfolio of 4.8 trillion pesos, which It represents approximately 53% of the total delinquent debt recorded therein.
Main debtors of the 221 hospitals and clinics that report in the ACHC study.
Photo:ACHC
State debts
In the State category for this cut, the total debt amounted to about 1.47 trillion pesos with a default of 991 billion pesos, approximately 67.2%. When disaggregating this value by the debtors that make up this category, it is observed that the Territorial Entities are the They concentrate a greater percentage of this portfolio with approximately 662 billion pesos.
It is highlighted that Norte de Santander is the one that owes the most to the institutions that reported to this study, with 150.9 billion pesos and approximately 134 billion in arrears, followed by Bogotá DC with a debt that exceeds 100 billion pesos and about 77 billion in delinquent portfolio and Valle del Cauca that owes 63 billion pesos and about 51 billion in delinquent portfolio.
Next, there are “Others” – where entities such as: the Judicial Branch, the Disaster Risk Management Unit, Police Inspections, the Executive Branch, among others – are grouped together, which together owe approximately 393 billion pesos . In third place is the Administrator of the Resources of the General Health Social Security System (Adres), which owes 325 billion pesos, which correspond exclusively to the process related to the recognition and payment of Claims for Traffic Accidents and Catastrophic Events. and Terrorists, that is, the other processes of recognition, payment and transfer of resources in favor of the SGSSS actors are not taken into account.
For Juan Carlos Giraldo Valencia, director of the ACHC, the study figures corroborate that the portfolio problem is a chronic, growing issue that is difficult to resolve.. “Delinquency rates continue to fluctuate at high levels, despite many policy and regulatory interventions,” he said.
Since the previous year, lACHC asked the National Government to adopt an Extraordinary Liquidity Plan, composed of several measures that together could improve the situation of the flow of resources and face the accumulated problems, especially with old portfolios and the damage caused by liquidated EPS that did not responded to their obligations.
Of the proposals of the original Plan, the National Government has already expanded the scope of the Direct Turn especially in the contributory regime, however, Decree 489 must still be applied to make 80% a minimum and guarantee that the resources reach the independent IPS and do not concentrate on vertically integrated entities. The remaining 20% must also flow into the sector’s liquidity, to honor current commitments and old portfolios.
Other mechanisms such as the release of technical reserves and Findeter credits must be implemented in the immediate term, according to the ACHC
Finally, the union insisted on the urgency of launching a Guarantee Fund that contributes to liquidity and allows it to respond for the debts of entities in liquidation. This figure could be derived from accounts such as those of the Fonsaet and the Financial Support and Patrimonial Strengthening of entities in the health sector, existing in the Adres and be nourished by funds that could come from sources such as the half point of Social VAT created in the tax reform of 2016.
The hospital union ratifies its commitment to adequate care for the population and with this study issues a new message of urgency. Liquidity in the provision of health services is essential to adequately respond to obligations with human talent in health and providers, essential aspects to guarantee the continuity of services with due quality, safety and timeliness.
EDWIN CAICEDO
Environment and health journalist
@CaicedoUcros
