BTN News: The Colombian government has once again ignited a firestorm of controversy with its latest health reform proposal submitted to the House of Representatives on September 13, 2024. Despite assurances from the Ministry of Health that broad consensus was achieved, many stakeholders, including business leaders, academics, and healthcare professionals, are voicing their dissatisfaction. Concerns are mounting over the government’s handling of the reform process, particularly its failure to address longstanding financial issues that have plagued the healthcare system for years. Critics fear the proposed changes could lead to the centralization of services, increase out-of-pocket expenses, and exacerbate the existing crisis in patient care and medicine distribution. As the debate unfolds, Denis Silva, spokesperson for Pacientes Colombia, speaks out on why he has lost hope in the new health reform but remains open to dialogue in a bid to find common ground.
1. Growing Discontent Over Colombia’s New Health Reform
The latest health reform proposal by the Colombian government has been met with widespread criticism from across the healthcare sector. Many stakeholders are troubled by the apparent lack of dialogue and consensus-building efforts. Despite the Ministry of Health’s claims of reaching a “grand agreement,” representatives from health-promoting entities (EPS), patients, and various organizations argue that their perspectives have not been considered in the new proposal. Concerns center around the potential for increased state control over healthcare services and a rise in out-of-pocket expenses, which had remained below 13% by the end of 2023.
2. Financial Strain and Service Fragmentation: Key Issues Highlighted by Critics
Experts worry that the government’s approach fails to tackle the fundamental financial problems plaguing Colombia’s health system. These problems have long impacted the entire healthcare value chain, resulting in service deficiencies and delays in medication distribution. Denis Silva, from Pacientes Colombia, notes that the government’s plan to shift from individual insurance to a social insurance model could leave patients vulnerable. “It’s like replacing a personal car insurance policy with a collective one,” Silva explains. “When the common fund runs out of money, so does the responsibility for patient care.”
3. Concerns About Patient-Centric Care Under New Reforms
Many are questioning whether the proposed reform truly places patients at the center of healthcare. Silva and other experts point out the risk of further service fragmentation with the introduction of multiple new entities such as the “Gestora de Salud y Vida,” primary care centers (CAPs), and territorial entities. “With three actors sharing responsibilities, no one is fully accountable,” Silva warns. Critics also highlight the vague financial provisions for complementary services, noting that patients may be required to prove their inability to pay before receiving necessary care. Silva stresses that without clear funding, these services might become effectively non-existent.
4. Potential Financial Fallout from the Reform Proposal
Financial experts have raised alarms about the potential economic fallout of the proposed reform. Projections on page 121 of the proposal document show a troubling trend: while a 12.7% increase in the Unit of Payment by Capitation (UPC) is anticipated for 2025, the expected increase drops sharply to just 3.7% by 2026, when the current government’s term is set to end. Silva argues that this suggests a decline in the quality and funding of the healthcare system, which is already suffering from underfunding and administrative burdens.
5. New Administrative Costs: A Growing Concern
The proposed reform also faces criticism for potentially increasing administrative costs without clear benefits. The creation of CAPs and other new entities will require substantial investment, yet there is no clarity on how many will be needed or how much they will cost. Silva points out that the “Gestoras de Salud y Vida” (current EPS) would receive nearly 8 trillion pesos regardless of their performance, and an additional percentage if they meet their duties. However, there is no technical study outlining the allocation percentages for essential funds like infrastructure, external teams, and patient care.
6. Lack of Consensus and Governance Challenges in the Reform Process
Critics argue that the reform’s lack of consensus stems from the government’s unwillingness to engage in genuine dialogue. Silva explains that although meetings were held, the outcomes were limited. “The agreement was that there was no agreement,” he says, citing the government’s refusal to amend even a single comma in the text. This unwillingness to compromise, he claims, reflects a broader failure of governance and managerial capacity within the Ministry of Health, which currently controls 57% of the nation’s health coverage through intervened EPS without demonstrating significant improvements.
7. A Surge in Legal Actions Reflects Systemic Issues
Recent data from the “Así Vamos en Salud” observatory shows a 42% surge in legal actions (tutelas) over the past four months. Silva attributes this increase to a combination of insufficient funding, declining public trust in the government, and the inability of EPS to continue providing services due to financial constraints. Additionally, widespread fear that the system might collapse has led to overuse of healthcare services, further straining the already burdened system.
8. Risks Ahead: What Does the Future Hold for Colombia’s Healthcare?
Silva outlines three major risks if the reform is implemented in its current form: a poorly organized transition period that could lead to a system collapse, potential loss of lives during the upheaval, and an uncertain timeline for recovery from the current healthcare crisis. He remains hopeful for continued dialogue but expresses concerns over allegations of vote-buying, inadequate technical expertise in Congress, and the possibility of government hardline stances if the reform faces defeat.
9. A Call for Active Participation and Financial Responsibility
Silva urges all stakeholders to actively engage in the ongoing discussions, emphasizing that the debate is just beginning. He reassures users that while the system is in crisis, it is still operational, and healthcare providers must continue to ensure patient care. Silva also calls for those with the financial means to contribute more to the health system, arguing that the current model of universal coverage without adequate contributions is unsustainable.
