IWe are 1 or 2 weeks away from knowing the text of the health reform proposed by Minister Carolina Corcho. Most likely, the reform would eliminate EPS as middlemen and propose the creation of a network of public and private providers organized by health secretaries, and for which citizens would register according to their place of residence. Financial intermediation will be eliminated as the state will directly pay these networks for consultations and procedures.
Colombia has many health problems, but the minister’s reform highlights two as the most important: many EPS, as intermediaries and risk managers, reduce their costs by denying services to their partners; and that they fragment service provision because they split people living in the same location among different insurers, reducing care and prevention responsibilities.
This diagnosis assumes that the competition model between EPS and IPS proposed by Law 100 does not work in most Colombian municipalities, where there are not enough people for a true market. In these places, EPS do not compete with each other to become more attractive to the user/customer.
In an investigation that I published in Latin American Politics and Society, I found that the effect of competition among insurers varies depending on the size of the municipality. In smaller municipalities, there is more competition between EPS with higher maternal mortality rates. In large cities, on the other hand, there is more competition along with lower maternal mortality rates. This was the original intention of the reform, but in towns, rural areas and sparsely populated areas, where there is no market, the fruits of competition could not be seen.
But while it is true that fragmentation is a problem for these areas, the solution cannot be to entrust the organization and management of the service to health secretariats that, precisely because of their high rurality and low populations, are poorly equipped, which have There is no technical or budgetary capabilities. , and are easily captured by corrupt political factions and criminal structures. If 30 years of Law 100 has shown anything, it’s that mayors and governors have done a pretty mediocre job of the collective health care they’re in charge of. And that part of the health problem in Colombia is completely downplayed in the minister’s diagnosis.
Replacing fragmentation in EPS with more decentralization is like opening a sinkhole and plugging the hole. Health decentralization since Law 100 has been irresponsible and disorganized, so giving more functions to regional entities that are most vulnerable is nonsense.