Bogotá, Colombia – The winds of change, steady yet urgent, blow through Colombia’s healthcare system, carrying with them the hopes of many and the concerns of some. As the Adres—Colombia’s healthcare treasury—takes on a more direct role, bypassing the traditional system of EPS payments to make transfers directly to clinics and hospitals, the nation holds its breath.
It is a transformation long whispered about in policy halls and shouted through the voices of reform, a shift towards making Adres the sole payer in a complex web of healthcare. But as with all shifts of magnitude, shadows lurk. While some see this as a step toward a more transparent, efficient system, others warn of doors that may swing open to corruption and mismanagement. Alejandro Gaviria, former Minister of Health, has stood firm in his criticisms, questioning whether one entity holding such power over payments could risk the integrity of the entire system.
A Change in the Wind: Direct Payments Expand
The heartbeat of this reform lies in the direct payments—a mechanism that now skips past the EPS, the health insurers, to reach the hands of those who provide care. This system had been in place before, but it moved slowly, tentatively. Until May of this year, Adres was moving around two billion pesos a month directly to hospitals and clinics. But when the sun rose on this year’s National Development Plan, the change was written into law. EPS, especially those in troubled waters or lacking the capital to pay their own providers, must now rely on Adres to do the job.
Suddenly, 4.5 billion pesos began flowing monthly from Adres directly into the hands of doctors, nurses, and caregivers. This new tide of money, two-thirds of the entire health system’s resources, now swells into clinics, hospitals, diagnostic centers, and other health service providers. The process is not without its rhythm—a steady hum of checks and balances, as Adres audits each claim, ensuring only what’s due is paid.
Fighting Ghosts: The Battle Against Fraud
But change, like water, finds both its channels and its cracks. Even as Adres strengthens its grip on the payment system, there are places where darkness seeps in. Félix León Martínez, the director of Adres, tells of the fight against the shadowy figures in the system—those elusive ‘phantom clinics’ that bill for services never provided. Just this week, 51 clinics had their payments suspended after it was discovered they were charging for treatments linked to accidents where no real vehicle or valid SOAT insurance was involved. Payments amounting to 70,000 million pesos hang in the balance, awaiting proof that these clinics are not mere figments, conjured to siphon money from the public purse.
“We cannot and will not tolerate the existence of ‘clinics on paper’—entities that exist only to exploit the system,” Martínez stated firmly. Each case where fraud is suspected will be referred to the Fiscalía General de la Nación, where those found guilty will face the full weight of justice.
Beyond Payments: A Vision for Reform
Yet, the horizon stretches beyond just direct payments. Under the reform, Adres stands to become not only the key payer but also a guardian of the nation’s health infrastructure, managing funds for rural health programs and overseeing emergency responses. This centralization, critics like Gaviria argue, creates fertile ground for the very corruption the reform seeks to avoid. He speaks with a warning in his voice, cautioning against turning Adres into a ‘megaentity’ where oversight may falter.
But Martínez, with steady resolve, pushes back against these fears. “Our work is guided by transparency,” he says, emphasizing that every peso moved by Adres is recorded and public. Through their online platforms, the details of each transfer are laid bare for any eye willing to look. Equality in payments ensures no hospital or clinic is favored over another—all are paid on the same day, at the same hour, in a system designed to resist the pressures of influence or corruption.
Facing Tomorrow: A Healthcare System in Flux
There is a rhythm to reform, one that requires both patience and persistence. As Adres stands at the heart of Colombia’s evolving healthcare system, the stakes have never been higher. The United Contribution Plan (UPC) payments, the lifeblood of the system, flow each month to those who care for the nation’s health. But there is still a deficit of five billion pesos, an echo of the fiscal shortfalls that have long haunted the country’s health budget.
For now, Adres is holding the line. With each passing month, a new billion pesos is infused, keeping the system afloat, even as the waves of change continue to swell. Martínez remains confident. “We are prepared for what comes,” he assures, pointing to new technologies that promise to double their capacity for handling payments.
But for all the assurances, the questions remain—can such a sweeping reform heal a system that has long been burdened by debt and delay? Will the move towards direct payments bring the transparency the country craves, or will it invite the very corruption it seeks to dismantle?
Time will tell. For now, the people of Colombia stand at a crossroads, watching the system shift beneath their feet. And in that waiting, there is both hope and uncertainty.
