Colombia: ABC of Gustavo Petro’s Health Care System

In LatinAmerican Post, we explain three of the most critical points of this reform that excites the national government and worries the opposition .

Gustavo Petro and the health reform

Photo: TW-petrogustavo

LatinAmerican Post | Christopher Ramírez Hernández

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Leer en español: Colombia: ABC de la reforma a la salud de Gustavo Petro

On February 13, the president of Colombia, Gustavo Petro, in the company of his vice president, Francia Márquez, and the Minister of Health, Carolina Corcho, officially presented the Health Care System reform document in that country. That same day, it was filed before the House of Representatives, with the aim that it be Congress that approves or not the reform.

There are 180 pages with 18 chapters and 152 articles, which make up the document that today has become a topic of discussion in Colombia. While the ruling party defends this change as a strategy with which to "transform the system to cover the entire national territory", the opposition labels the reform as a setback in the country.

Thinking about this, LatinAmerican Post brings an ABC of what the health reform is , in view of the official document offered by the Colombian Government, and in favor of objectively explaining some of the most critical points of it.

Prevention and Prediction from the Territories

To begin, it is important to highlight that in addition to the universality that Gustavo Petro intends to ensure with his reform, prevention, and prediction are two terms and practices that the Executive defends.

“The change towards health for life proposes a preventive and predictive system. This implies guaranteeing the quality of life of Colombians to comprehensively cover all the factors that influence their health. From the satisfaction of their basic rights, through mental health care, to the monitoring and timely diagnosis of diseases”, explains the official document.

To achieve this objective, the new health system will be based on a territorial rather than a population strategy, in which Colombians will receive medical care according to the geographical area in which they live.

In this sense, the Primary Care Centers (CAP by its Spanish acronym) enter as the protagonists of this reform, since they become the main (and almost unique) spaces that will attend to the health of Colombians.

According to the Government, the function of these CAPs "will not only be to care for patients, but to organize the territory in an average of 25 thousand people for each one and distributed according to the place of residence or work." In other words, the system changes in the sense that each citizen will be registered at a single office where they will be attended, and it will remain in a place close to their residence.

What is intended with this initiative is that the CAPs are responsible for their respective territories, not only in care in the physical sites, but also in visits to the families sheltered by their jurisdiction.

"In this way, the medical teams will permanently, routinely and constantly visit the families of said territory, wherever they are, to reduce the causes of the disease, eliminate it if possible or attend to it even in a primary state where it is still possible to save life ”, adds the Government.

Now, this does not mean that people cannot be attended in centers far from their homes. If necessary, the CAP in charge (after the patient's request) will refer them to clinics, hospitals or medical centers of medium and high complexity where they can receive specialized care. These spaces will be coordinated by the Comprehensive and Integrated Networks of Health Services (Riiss by its Spanish acronym).

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And the EPS?

As explained by the Minister of the Interior, Alfonso Prada, the health reform project will not put an end to the Health Provider Entities (EPS by its Spanish acronym), on which medical care in Colombia revolves today, since "they are going to fulfill a fundamental role. It takes the 30 years of experience” they have. However, "changes are required."

In this sense, the Government document informs that, at least for the first years, the EPS will become the administrators of the CAPs, managing the resources that the ADRES (Administrator of the Resources of the General System of Social Security in Health) as sole payer available for each of them.

Thus, the EPS "with optimal financial statements will receive, in a progressive and orderly manner, their patients so that they are not left without coverage", while those that are in liquidation will be eliminated.

The worrying thing about this situation is that, according to Corcho, of the 27 active EPS, only eight could meet the requirements to be part of this reform. The patients of the eliminated EPS will be sent, for the most part, to the New EPS (with majority shares of the State). So that the entity will be in charge of offering coverage to the territories that are currently abandoned or that would run that risk with the liquidation of some EPS.

Finally, the Government indicates that after completing the transition, "the EPS that are conditioned and believe that they can coexist within the new prevention and primary care system will have all the possibilities of developing their corporate purpose as Healthcare Provider Institutions (IPS). and/or audits of the collection to ADRES”. In other words, they will go from organizing health to being intermediaries for the State.

A Mixed System

Finally, it is important to highlight that, although the transition towards the nationalization of health in Colombia seems to be the path that the current government is seeking, private services will still be preserved as a democratic alternative to the free choice of Colombians.

"Complementary plans, prepaid medicine or health policies will continue to function normally and will not be affected by the project," dictates the Executive. In this way, the government of Gustavo Petro concludes that its reform takes into account the private sector as an ally "in the provision of the service, in its clinics and hospitals."

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