In February, the health reform of Gustavo Petro’s government will be introduced and controversy is the order of the day. The full text is not yet known. Minister Carolina Corcho is criticized for her intention to introduce drastic changes to the Colombian system, recognized internationally for its merits.
In recent months, the minister has moderated his strident speech against the EPS, but that doesn’t entirely quell the concerns of experts. In any case, it is still considering eliminating the insurer or intermediary role of said entities, focusing the system on a preventive and predictive model. It will be managed by regions and regions, giving these authorities the ability to pay obligations to hospitals and clinics.
In the midst of the debate, various social and educational organizations have tried to contact Corcho to learn the lessons of the reform and contribute to its creation. But leaders of these institutions say the minister has not taken up the task of socializing the text and does not share it for analysis. The complaint has even been “vetoed” from events organized by the Ministry of Health for the purpose.
For this reason, a group composed of civil society organizations, experts, academics, a constitutional lawyer and two former deputy ministers of health is producing a bill that synthesizes their proposal for the Colombian system. The initiative is led by the Patients Colombia movement, an organization that protects the rights of people living with complex diseases.
“We do this because the ministry has not given us permission to participate. The minister, whom we respect, has a line of work in which there is no one like him,” Dennis Silva, a spokesman for the organization, told Semana. Thinks, he is against them.
That’s why he brought together German Escobar and Diana Cárdenas, former deputy ministers of health; Aquiles Arrieta, former assistant magistrate of the Constitutional Court; and consultant Ramon Abel Castaño, health systems specialist. In this way, they seek to create a system that builds on the good of the existing model and removes its shortcomings.
The text consists of eight chapters which point towards a public-private model, such as the EPS. Unlike the government, the group of experts does not believe it is necessary to abolish them.
“We have much more serious problems than EPS. The unions know our proposal because we shared it with them last year. We are not talking about these entities, we are talking about a regulator, not the government. That’s where we go,” Silva said.
German Escobar, Ivan Duque’s former deputy minister of public health and one of the authors who recorded his thoughts in the text, detailed the strategy against these entities.
“Some functions are taken back, especially in public health, which is the truth that they have not been able to do it well in these 30 years. Second, a new level of coordination arises for them, that of national government and regional institutions. It doesn’t exist at the moment and they will have a real boss in the task of risk management”, he told Semana.
Furthermore, he said that EPS would also change their name and be called “management agents” or “modulators”.
Thus, according to the project, these public health functions would remain in the hands of regional institutions. “Vaccinations are one example, which the EPS is in charge of, but should be directed by the regional unit. It has to have a complete technical scaffolding and a traceability system,” Escobar explained.
One of the great changes proposed by the civic project is to give power to regional bodies and the government to study needs in the context of hospital networks, whether public or private. The EPS should meet the needs by adjusting the municipality’s offer, thereby preventing users from obtaining medical care in other municipalities.
In return, the group proposes that, under quality and health outcomes criteria, supply subsidies be given to maintain the operation of many hospitals in vulnerable areas. According to Escobar, the first difference with government reform is the number of participants in the creation. “The minister is not socialized and doesn’t understand very well what she wants to do,” the former official said.
On the other hand, he said that the portfolio managers “are ignorant of the real function of the EPS, which is to manage the health risk of Colombians.” Finally, the former deputy health minister assures that, unlike what the government has proposed, his project has a defined transition period and application parameters so that the transition is as less painful as possible.
On his behalf, Ramon Abel Castaño, an expert in health systems, The project created by a group of citizens also makes a difference in the context of the minister’s idea of implementing coverage by area, he said.
Academically, from population silos, with coverage of different EPS for people living in the same place, to territorial silos, in which one unit covers all residents of the same place without exception, This is dangerous for people who benefit from special programs for diseases such as hemophilia or high blood pressure.
“You lose all that learning curve and intellectual capital because it’s nuclear. Plus, it remains under the control of regional entities. Patients don’t want to lose this coverage,” Castaño explained.
How will Congress get this?
According to a spokesperson for Patients Colombia, the group is looking for congressmen to present the project in Congress. For now, he’s talking with lawmakers from the Democratic center and even the historic Pact, but it’s not yet decided who will side with his initiative. The truth is that there is no unanimity in the ruling party regarding the health system of Minister Carolina Corcho.
According to Escobar, the idea is to debate it alongside the government’s health reform and incorporate it later: “When several bills are introduced on the same subject, they are grouped together into a consolidated form by the case unit. Should be discussed as much as possible. project”.
Similarly, he insisted that a consolidated text with legal reasoning would be presented, noting that it had undergone several amendments by constitutionalists. “We believe that it is a text, from a legal and technical point of view, well structured, but of course, susceptible to improvements discussed in Congress”, said the former deputy minister.
So far, this is the reaction of a group of citizens who claim to be marginalized from the discussion, to the first brushstroke of health reform by Minister Corcho. Many experts agree that this counterproposal is not the only one being developed and that several projects on the subject may converge in Congress.
The health reform bill, one of the most important in the government’s reform package, which will be processed this year, continues to instill fear among citizens, as a system providing a vital service with 30 years of learning and consolidation comes to an end. Might be possible. The minister, increasingly conciliatory and unwilling to break the build of several decades, tries to convince Colombians that this is the way to go.