During a recent forum of matter, various experts alerted about the financial risks of the proposed Health reform by the national government.
The president of the Senate, Efraín Cepeda, said that the system faces a deep crisis due to irresponsible ideological decisions, and criticized the impulse of a reform without financial support, especially in a context of fiscal crisis.
(See too: Coup for affiliates to new EPS in Colombia: Government made drastic decision with entity).
Cepeda denounced that the government has breached the system, causing debts over 6.3 billion of pesos in entities like new EPS and Sanitas.
For his part, Jorge Coronel, advisor to the Ministry of Finance, recognized problems in efficient use of resources and highlighted the need for a new financing model, eliminating intermediaries such as EPS and giving that function to ADRES.
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Experts like Ramón Abel Castaño warned that eliminating key functions from EPS without adequate Expenditure control could aggravate The situation in the national territory.
In addition, Diego Gil, from the Colombian Federation of Rare Diseases, said the reform It does not guarantee sustainability to treat high -cost diseases.
-Together, panelists They agreed that the initiative It could make the current situation of the health system worse.
How EPS operates in Colombia
In Colombia, health promoting entities (EPS) are the central axis of the health insurance system established by Law 100 of 1993. Its main function is to affiliate citizens to the general Social Security System in Health (SGSSS) and guarantee access to medical services included in the Health Benefits Plan (PBS), previously known as the POS. EPS act as intermediaries between the State, users and health service providers (IPS), organizing medical care and managing economic resources aimed at covering these services. There are two affiliation regimes: the contributory, to which those who have payment capacity (workers and employers) belong, and the subsidized, who covers people without resources, mainly financed by the State.
The EPS are responsible for collecting the contributions of the affiliates to the contributory regime, managing the resources assigned by the system and hiring with the IPS to provide health services. Its responsibility is to ensure that users receive timely, continuous and quality care, from basic services such as general consultation, medicines and exams, to surgical interventions, specialized treatments and prevention programs. To do this, they must have an adequate network of providers and comply with quality and efficiency indicators that are monitored by the National Superintendence of Health and the Capitation Payment Unit (UPC), which defines the amounts that the system pays for each affiliate, depending on its age, sex and other variables.
One of the most criticized aspects of the EPS model is its mixed character, which allows the existence of private for profit managing public funds. This has generated problems such as delays in the authorization of services, administrative barriers to access treatments, and growing debts with clinics and hospitals.
How is EPS’s coverage in Colombia
In spite of this, EPS have also allowed to increase the coverage of the health system to more than 95% of the Colombian population, achieving important advances in vaccination, disease control and maternal care.
In conclusion, EPS are a key piece of the Colombian health system, with functions that range from the affiliation of users to health risk management. Although the model has been subject to reforms, criticism and proposals for transformation or elimination, it remains the main mechanism through which Colombians access medical services. Its efficient or poor operation has a direct impact on the quality of life and the well -being of millions of people.
* Pulzo.com is written with z
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