BTN News: The health system in Colombia is in a critical state, a situation that could easily be described with the somber tone of a medical report: the patient is very ill, and despite the treatments applied, vital signs are worsening as the disease spreads to other organs. However, this is not about an individual’s health, but rather the alarming condition of Colombia’s healthcare services. The deterioration goes far beyond the financial struggles of the EPS (Health Promotion Entities), which are just the first link in a failing insurance model that remains in place. The entire healthcare system, from clinics and hospitals to the patients themselves, is in jeopardy, with mounting evidence highlighting the gravity of the crisis.
For months, warnings have circulated about the impending collapse, and now the domino effect is clearly evident. The distressing statistics speak volumes. According to the Superintendencia Nacional de Salud, the number of complaints and grievances has hit a historic high, with double-digit increases compared to the previous year. This spike is largely due to barriers in accessing treatments and medications, a sign of the system’s declining capacity to fulfill its obligations.
Furthermore, data from Así Vamos en Salud’s August bulletin reveals a startling 42% increase in tutela actions in the first third of 2024 compared to the same period last year, totaling over 84,445 cases. These legal actions, which are often the last resort for patients seeking their rightful healthcare, point to a significant erosion of the right to health from the users’ perspective.
On the financial front, the situation is equally dire for healthcare providers (IPS). The Colombian Association of Clinics and Hospitals reports that as of December, these institutions were owed a staggering 16.8 trillion pesos, an increase of 700 billion pesos in just six months. While the financial crisis of the EPS garners more attention, the silent financial meltdown among hospitals and clinics is just as severe, if not more so. Many of these institutions are barely holding on, caught between the Hippocratic oath and the fear of financial collapse. Their struggle to stay operational is becoming increasingly desperate, with some nearing the point of no return, unable to purchase essential supplies.
The broader impact of this economic crisis on healthcare service delivery remains to be fully quantified. On the surface, the slight increase in hospital beds between 2023 and 2024 might suggest that things are not as bad. However, other indicators tell a different story. An upcoming analysis, which examines mentions of liquidity issues, employee payment delays, and service cuts or closures across news reports, social media, blogs, and online comments, reveals a staggering 119% increase in such incidents. Recent media coverage has also highlighted the worsening situation across the country.
In June, the media in Santa Marta reported that workers at the Subsanar IPS blocked a major avenue due to unpaid wages, a scenario mirrored by similar protests in Armenia, Cúcuta, Riohacha, Ibagué, and Floridablanca. In these locations, the healthcare services have been severely strained, with some facilities experiencing a surge in patient load due to the closure of other clinics and hospitals in the region.
Meanwhile, the EPS are faring no better. A study by Sectorial.co shows a troubling trend: the claims-to-premium ratio (siniestralidad), which should ideally be below 100%, has been steadily climbing—from 103% in 2021, to 106% in 2022, and 109% in 2023, with the first quarter of 2024 reaching 113%. Even well-managed entities like Sura and Salud Total have seen their ratios spike to 125% and 100.7%, respectively, indicating the magnitude of the challenges they face. The situation is even more alarming for recently intervened entities, with the siniestralidad of Nueva EPS skyrocketing to 151%, a clear indication of the state’s poor management.
The root causes of this crisis are multifaceted and have been brewing for years. It would be unfair to place the entire blame on the current administration, as these are structural problems that have accumulated over decades. However, the government’s failure to reverse these trends and its missteps in exacerbating the issues are certainly subject to criticism. According to health systems researcher Andrés Vecino, the inability to curb the growing financial deficits can be largely attributed to a general shortage of resources, which has accelerated a vicious cycle of financial scarcity. But perhaps the most significant factor is the lack of political will to address the system’s financial woes.
A recent example of this reluctance can be seen in a letter sent to the Minister of Finance by over a hundred prominent figures, including former ministers and economic leaders. They urged the government to reallocate 2.5 trillion pesos from the Ministry of Health’s budget, specifically from infrastructure and regional staffing, to healthcare insurance. The letter pointed out that the Ministry had made the unprecedented decision to allocate 5.05 trillion pesos for purposes other than originally planned. If this reallocation does not happen, it will be impossible to meet the upcoming payments, further worsening the financial crunch. However, President Gustavo Petro quickly dismissed the request, arguing on social media that the per-user amount delivered by the state to the EPS had already increased above inflation, hinting at potential mismanagement of these funds.
This response highlights the government’s unwavering stance that the financial resources are sufficient and are being disbursed on time by the Adres to the EPS and hospital networks, which are then supposed to pay the various providers. From this perspective, the financial troubles stem from issues such as lack of transparency, inefficiency, corruption, and vertical integration within the system. The official narrative suggests that these issues create incentives for healthcare conglomerates to shift profits to their own clinics or prepaid plans while leaving the EPS to bear the costs.
In contrast, many academics, patient associations, and industry groups argue that an immediate injection of funds is critical, starting with addressing the arrears identified by the Constitutional Court. Ana María Vesga, president of Acemi (the main association of EPS), emphasizes the urgent need for a technical consensus on financing the system. She argues that it is crucial to acknowledge that the UPC (Unit of Payment by Capitation) is insufficient and that the actors cannot bear the financial risk of recurrent delays in payments for high-cost medications. Without resolving these issues, it is unrealistic to consider the model change proposed by the government. “Let’s solve the current crisis, which is very critical,” she adds.
Despite ongoing meetings with various associations and groups, the government remains determined to push forward with a reform bill, which is expected to be presented to Congress next week. Those familiar with the situation suggest that the administration’s stance has not significantly shifted, despite the deepening crisis and the growing calls for immediate action to stabilize the system. As the situation continues to worsen, the health system in Colombia teeters on the brink, with little indication that relief is on the horizon.
