BTN News: After the health reform proposed by the Government collapsed in early April in the Senate’s Seventh Commission, the idea of creating a concerted text that includes various proposals to achieve the most effective changes for the health of all Colombians has reemerged. Despite the current system boasting nearly total coverage and out-of-pocket expenses not exceeding 13%, numerous experts argue for necessary changes and improvements in its structure. The ongoing debates, coupled with the financial crisis that has affected the entire value chain for years, have led many users to consider the diverse range of private services available in the market.
Statistics reported by the Satellite Health Account (CSS) of Dane for health insurance companies, both private and public, reveal that voluntary payments for health services represented an estimated 78% of their income, translating to approximately 10 trillion pesos in 2022. Furthermore, according to the latest Dane Quality of Life Survey, 3.8 million inhabitants pay for additional health services. Estimates by entities like the Colombian Association of Comprehensive Medicine Companies (Acemi) suggest that around 23% of Colombians could contribute to this model based on market behavior.
The discussion revolves around complementary health plans offered by Health Promotion Entities (EPS) to their affiliates. These plans provide different benefits and coverages than the Mandatory Health Plan (POS), ranging from access to a broader network of specialists and clinics to private rooms during hospitalizations. Affiliates pay an additional fee to obtain these benefits, aiming to improve the quality and comfort of their medical care.
Another well-known model is prepaid medicine, a non-mandatory system where users pay a fixed monthly fee to an insurer for private medical services considered high quality. Unlike the public health system, this model grants direct access to an exclusive network of specialists, clinics, and hospitals with shorter waiting times. Prepaid medicine plans generally include consultations, exams, treatments, and hospitalization, along with additional services like home care and various wellness and prevention programs.
In the health services market, prepaid medicine has the largest share at 57%, followed by health insurance policies at 27%, and finally complementary plans and prepaid ambulances at 16%. The preference for these private services is mainly due to shortcomings in the public healthcare system, which often results in slower service delivery.
According to statistics from the observatory Asà Vamos en Salud, the average waiting time between the assignment of the first appointment and the actual date is approximately 4 days. However, this increases significantly for specialist consultations, with the wait time for general surgery appointments rising to about 11 days, a similar situation for specialties like internal medicine and gynecology.
In addition to appointment delays, issues like appointment cancellations and medication delivery problems are prevalent. The National Health Superintendent, Luis Carlos Leal, reported high complaint rates across almost all EPS, with larger entities like Nueva EPS recording over 50,000 affected users.
Given the complexity of the national public hospital network, particularly in remote areas, telemedicine has gained significant traction in Colombia. Various companies are investing in digital technologies to enable remote and customized consultations. Telemedicine allows patients to receive specialized care without traveling long distances, which is particularly beneficial for those with mobility issues or chronic conditions requiring frequent consultations.
Telemedicine can improve public health by ensuring timely care for more people and optimizing medical resources while reducing costs for patients and health systems. Remote consultations reduce the need for physical infrastructure and personnel, leading to significant savings. This model also facilitates the management and monitoring of chronic diseases through constant monitoring and treatment adjustments without requiring in-person visits. This efficiency can contribute to the economic sustainability of health systems, especially in resource-limited contexts.
The integration of advanced technologies in healthcare through telemedicine is another significant benefit. Digital platforms for medical information exchange, teleconsultation, and telemonitoring enable more personalized and accurate care. Artificial intelligence and data analysis tools can identify patterns and predict complications, enhancing clinical decision-making. This technological integration not only improves care quality but also fosters continuous innovation in the health sector.
Developing digital tools to meet these needs has been a significant challenge for organizations. Among the market options is Doctoralia, a digital showcase for doctors that also provides online exposure for health professionals, aiming to improve accessibility, efficiency, and personalization of medical care, benefiting both patients and specialists.
In conclusion, the need for health system reform in Colombia remains urgent, with private services playing an increasingly significant role. The rise of telemedicine and other digital health solutions points to a future where healthcare is more accessible, efficient, and personalized, addressing many of the current system’s shortcomings. As the debate continues, the focus must remain on creating a healthcare model that ensures high-quality, timely care for all Colombians.
