BTN News: The ongoing financial crisis in Colombia’s healthcare system has been a pressing issue, and recent developments highlight the government’s commitment to addressing these challenges. On August 22nd, the Minister of Health, Guillermo Alfonso Jaramillo, held a significant meeting with the Asociación Colombiana de Hospitales y ClÃnicas (ACHC). This meeting aimed to reaffirm the government’s pledge to transforming healthcare in the country and to ensure that the rights of Colombians are upheld. The session was especially crucial given the current financial turmoil within the healthcare system, which has spurred urgent calls for reform.
In this context, the Ministry of Health has been working diligently on a healthcare reform project, though details remain sparse. There is speculation that the proposal will be officially presented in the coming week. The discussions between the Ministry and ACHC are particularly noteworthy, as the ACHC has previously communicated with the government through three separate letters, urging adjustments to the direct payment model, also known as the “giro directo.”
In an effort to find solutions to the financial woes plaguing the system, the Ministry of Health recently enacted Decree 489 of 2024. This decree has allowed the Administradora de los Recursos del Sistema (Adres) to disburse a substantial 44.8 trillion pesos over the last six months. These funds have been directed straight to hospitals, clinics, service providers, and technology providers within the healthcare sector. The adjustments made to the giro directo mechanism within the contributory regime have facilitated this financial flow, resulting in an 88.82% increase in direct payments to IPS (Health Service Providers) compared to the same period in 2023.
While the giro directo mechanism has undoubtedly improved the flow of resources, the ACHC continues to push for further refinements. Despite acknowledging the benefits of this direct payment system, the ACHC has expressed concerns about the vertical integration that characterizes the current healthcare model. This integration often results in funds not reaching independent IPS, whether public or private, that lack direct affiliations with certain EPS (Health Promotion Entities).
The ACHC, in a letter dated July 29th, emphasized the importance of closely monitoring the giro directo mechanism to ensure that at least 80% of the capitation payment unit (UPC) is disbursed, with the ultimate goal of maximizing this percentage. They have also urged the government to clarify to EPS that this 80% should not be considered a payment ceiling for hospitals and clinics. In simpler terms, the ACHC is advocating for the resources allocated through the giro directo mechanism to align more closely with the actual invoiced amounts and for the remaining 20% of funds to be released promptly, allowing healthcare providers to settle their outstanding debts on time.
The ACHC further explained that healthcare providers often operate with minimal reserves to sustain their operations and meet obligations. Therefore, it is imperative that they receive timely payments that correspond to the services they have provided and invoiced. Any delay in receiving sufficient payment from EPS could lead to a cumulative deficit that may render certain services unsustainable.
The ACHC’s concerns have gained traction following the Adres’s publication of the ‘Top 20’ list of IPS and service providers that have benefited the most from the giro directo mechanism. The data, which is publicly accessible, reveals that entities such as Colsubsidio, Cafam, ClÃnica Colsanitas S.A., Cruz Verde, Audifarma, the National Cancer Institute, and Suramericana’s Health Services IPS are among the top beneficiaries.
While the ACHC recognizes the significant financial relief provided by the giro directo mechanism, they emphasize that the main beneficiaries are those with direct ties to certain EPS due to vertical integration. The association believes that now is an opportune moment to address this issue by reviewing compliance with the 20% threshold on contracting and the relationship between EPS and vertical integration, as outlined in Law 1122 of 2007. In the Adres’s published data, at least half of the top 20 beneficiaries of direct payments under the contributory regime have some level of affiliation with EPS.
As the country awaits further details on the healthcare reform, the ACHC’s call for adjustments to the giro directo mechanism underscores the ongoing challenges within Colombia’s healthcare system. The proposed reforms, which the government has described as part of a broader consensus, are expected to be presented in the coming days. The outcome of these efforts will be crucial in determining the future sustainability of healthcare services across the nation.
