The Office of the Chamber made an urgent call to the Government on health financing reform

On the morning of March 28, the General Hall of the Republic, Carlos Hernán Rodríguez, presided over the health reform forum. There he made an “urgent call” for the Government to clarify in more detail how the policies would work if the bill were approved.

First, the comptroller recalled some of the achievements that the Colombian health system has made in recent times. He gave an example of the insights he obtained, as he said it went from 29.77% in 1995 to 98.78%, according to data from 2022.

“But in the current system, problems of accessibility, quality, and opportunity prevail, which leave health inequalities for many Colombians,” said the comptroller.

Again, it shows that the EPS owed to other players in the system is close to 23 billion pesos, according to the latest figures. “Therefore, It is important not only to clarify the amount of obligations that remained unpaid as a result of forced and voluntary EPS liquidation processes.but also, the need to implement tools that allow better guarantee to the creditors of the entities that make up the sector, “said the comptroller.

He held the same The delegate for the region of the health office of Aulæi has carried out almost 247 hearings of various actors in the system since 2020.

“On the contrary, between 2008 – 2022 the CGR initiated 1,474 processes of fiscal responsibility for health resources for 5.5 trillion. of pesos and in addition, it carried out 170 coercive collection procedures for the amount of 1.6 trillion pesos; 910 judicial deposits for the amount of 94,000 million pesos, “said the comptroller.

According to the figures that he shared, they found about 28 findings that alleged criminal involvement and that had to be transferred to the Office of the Attorney General of the Nation. The same thing happened with another 1,692 findings with an alleged disciplinary incident, which passed into the hands of the Attorney General’s Office.

“Also, about 200 billion pesos have been listed, corresponding to the last three fiscal years, covering almost the entire path of the Health facilities, starting from Addresses as the entity that revolves around the facilities, going through the EPS and Obligations entities. Compensation, including public and private IPS, as the last of the same recipients”, Rodríguez added.

Speech problems

One of the issues that Aululus Rodríguez touched upon in his speech caught the attention of several forum attendees, such as the former Minister of Education, Alejandro Gaviria. These problems are in the management of the Resources of the General Administrator of the Social Security System in Health (Adres).

Rodríguez stated that in 2021 the Office of the Special Inspection of the Action of (Adres) There he developed a claim for health care that was made after the non-Soat trades that happened between 2018 and 2021.

In these investigations, the Office of the Prosecutor showed “some controls by the said entity in the process of recognition and payment of health care, in the weaknesses present, as well as in the absence of control points; obtaining the result of seven tax discoveries worth 13,955 million pesos”.

If the health reform is approved, Adres will be the entity in charge of directly paying health care providers (a function that currently corresponds to the EPS), for which the comptroller said he would keep his eyes on that one.

“We have to express my great concern about the risk of losing resources if the appropriate adjustments to the ADRES processes are not carried out,” said Rodríguez.

And he said that he was mainly referring to three: the shortcomings that Adres has to follow the resources of the health system, for example, in guarantees for non-Soat services and recoveries through EPS; absorption of hearing processes that are key to facilitating the flow of resources in the system; and the structural weaknesses that ADRES has, which in the lack of human talent and the difficulties that it has in paying claims, allow it to recover resources.

So far, the writer has shown that there should be greater clarity in the individual processes of hearing and monitoring for financial resources, which will begin to be managed differently, if the health reform is approved.

“For all this, here is an urgent call to the national government to refer to the structure of the cost of the Auditorium and the previous studies, on which the projection of the same was based”; Amulator affirmed and said to clarify that this is the key to ensure that there is sufficient control and supervision on the part of the entity he is in charge of.

Another concern found in the health sector

In addition to the concerns expressed by Rodríguez de Adres, he mentions some of the findings that the Auditor’s office has made in recent years in relation to different actors in the health system.

He recalled, for example, this entity found control of Capitation Payment Unit (UPC); the amount that Adres pays for any EPS patient exceeds the limits established by law in respect of administrative expenses.

They also found “a better value in contracts with the network provider due to the lack of medical hearing, billing control and wholesale management.”

On the other hand, Rodríguez stated that the advances made by the EPS to the health provider’s safety nets were found to be illegal.

He also warned that money from the UPC had gone to pay for services for patients who had already died. “In other words, the EPS took the resources for these users of medical care at the time, without the money paid into the system,” the comptroller pointed out.