In the middle of the review table of the Capitation Payment Unit (UPC) with the Ministry of Health – ordered by the Constitutional Court in January of this year -, the Colombian Association of Company Companies of Integral Medicine (ACEMI) addressed the inclusions of new services, technologies, medications and medical procedures covered by the health benefits plan (PBS). In that sense, the organization that brings together health promoter entities (EPS) of the contributory regime warned that these additions requires more review to ensure its cost -effectivity and financial sustainability of the system.
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It must be remembered that the PBS is the set of services and technologies to which all affiliates to the health system are entitled (of the contributory regime and subsidized equally) and whose provision must be guaranteed by the EPS. This plan is updated by decree of the Minister of Health annually in December and in that process they are included or eliminating services, to the point that there are currently more elements that are covered than those that are not.
In this regard, Acemi recalled that this process, which aims to guarantee equity and quality in access to health services, must be veiled by financial protection and ensuring the right to population health. In fact, they indicated that between 2020 and 2024 the inclusions increased by 31.5 %, which shows an increase of 3,900 to 5,127 services in last 5 years.
That finding was the one presented to the Ministry last week, along with other analyzes that revolve around that, according to the guild, there is no comprehensive literature or studies of the impact of inclusions on spending per user for the period 2021-2024. “The necessary information to develop these analyzes is in the hands of the Ministry of Health and is not shared to external,” they said.
They also pointed out that studies carried out by some EPS with selected technologies and their own information “show an insufficient budgeting of resources for the inclusions carried out” in those years.
-In the same way, that the process of inclusion of health services financed with UPC “has been incomplete” because it focuses on the initial phase of identification and prioritization of technologies, “but does not address posterior key aspects such as initial costing and budgeting, the monitoring scheme and the evaluation of results and impacts.”
ACEMI called on the inclusion process should have “greater guarantees of transparency”, since the technical documents that support the decision are not public domain or “are superficially developed in studies of sufficiency.” In that sense, they criticized that “minutes, studies or presentations of the Beneficial, Costs and Rate Advisory Commission are not known nor do you have access to the databases of sufficiency and access to Mipres (plateror of the Ministry of Health) with Payment and Expenditure Module.”
“Mechanisms of backtesting (predictive model using historical data) of the expense actually carried out for technologies included in PBS versus previously made estimates and adjustments ex post (later) In case of material deviations, ”said the aggregation.
Finally, they called to boost the exclusions mechanism to update the PBS and optimize resources to improve health results; as well as to “resume an explicit plan of benefits, eliminating the current negative list principle. To achieve this objective, dialogue and political and legal consensus is required.”
The Health Guild filed during the table with the Ministry the technical document that sustains these criticisms and that account for the impact that the additions have had. The next session of this work table – in which other actors of the health system also participate – will be this April 29 and the risk settings analysis will be addressed.
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