These are the government’s plans for the system’s finances | Government | Economy

Health system finances have always created uncertainty for many players, despite organizational and The development of the entity responsible for the disbursement of resources in the sector is working to stabilize the situation in the region.

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Félix León Martínez, Director of Resource Management of the General Health Social Security System (Adres), He discussed with Portafolio the entity’s plans, resource management, and their strategy with the immediate family. In addition, he explained the health reforms they were going to propose and some modifications to them.

How’s the accounts?

These are the numbers. We will execute about $71 billion in 2022, $82 billion in 2023 and reach a budget of $92 billion in 2024. It must be taken into account that the contribution to health is made gradually, for example, the government’s resources are calculated at 9%. But then the regulatory committee meets to determine the UPC and approves 12%. The budget is merged, increased and finally completed.

Last year we had a supplement by December 28. They gave us $1.5 billion, but the Department of Labor did not enforce it. The UPC was protected first. There are many other small expenses that sometimes are not funded at the beginning and need to be resourced little by little.

The top budget does not start funding at the beginning of the year. It started the year at $400 billion and is now at $2.5 trillion. We are currently at $92 billion, but we have increased it to about $94 billion. From 2022 to 2023, the increase is 15%, and we are already at 11.5%.

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Are they going well or nervously?

We have done well, as the Minister of Finance said, health resources are guaranteed and will not be affected by cuts. The state has been responding, for example, the universal participation system and contributions to the state budget must complete the closure of social security payments. That’s the mechanism. But it will always grow, higher than investment, and they are safe resources.

In terms of investment, the first is the state budget and the second is the workers’ contributions. I want to remember that this item was very important before in Law 100, but it is no longer important because employers no longer contribute. With the tax reforms in 2012 and 2017, their contributions are no longer required.

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Will this situation change with the reform?

You are not thinking. The project does not make any changes to the types of taxes, whether income or contributions. I expected at the beginning of this administration that in tax reform, businesses would contribute more than three times the minimum wage. Today it is 10 SMLMV.

But the government did not want to increase or take back part of the contributions. He showed no interest and reasoned that it would remain the same. And the reform did not touch on the tax side, because that would make the reform more difficult and complicated.

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Why is the system of universal participation becoming increasingly stronger?

The tax reform that was done increased the revenue from the universal participation system, the constitutionally mandated revenue from municipalities. The reform said that this money should flow more to municipalities and primary care. We should not concentrate this money in the big cities.

On the expenditure side, there are two big ones, the UPC for the contributory system and the UPC for the subsidy system, each at $40 billion, and a maximum budget to pay for services not considered in the UPC.

In addition, the government’s annual financing contribution to the system is 25% from 2022 to 2023, and so far we’ve been at 20% from 2023 to 2024. I don’t think that’s completely eliminating the financing of the system.

Is this reflected in the UPC? Because it is said that there is insufficient funding.

Here $7 billion is holy rotating every month, money in the system is moving regularly and there is no shortage. The other thing is that some EPS say that this is not enough for them. Adjustments have been made. There is a dispute about this, but so far the ministry has not found a reasonable justification. The data provided by the EPS does not justify its insufficiency. We are doing another review with the Ministry of Finance and we find again that there seems to be no justification.

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What did you notice with Sanitas’ involvement?

There are also a number of issues with expenditures. For example, in many accounting practices, accountants are not consistent in terms of technical reserves and how to include or deduct technical reserves at cost. Some are not considered completely acceptable.

We have another question on EPS, which is the per capita spending last year. Three EPS needed more resources, but they said they didn’t have enough resources, but the most per capita resources were almost $1.8 million per patient, while some of the others were $1.2 million.

There is also a characteristic of how the maximum budget is spent between the contributory and subsidy types when the population is the same. There is a huge difference between the two systems, with the contributory system having a higher value.

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Why do prepaid customers spend more?

The system fee for those prepared affiliates was 3.4%, which means that the regular affiliates who were not prepared cost 1%, while the system fee for the prepared affiliates was 3.4%. It turns out that the EPS they prepared provided a special service, but they charged all the fees to the system, and the system eventually paid for the fees, except for other queries.

Take Sanitas for example, they had a loss of $200 billion in 2022, but their prepaid company and their clinics made a profit of $500 billion. That is, they are somehow shifting profits to their affiliates, and then they ask for money from the earnings per share.

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There were complaints about non-payment of the 2022 maximum budget, what happened?

In 2023, we pay the 2021 adjustment that the previous government did not finance. At the end of that year, we get the money for the 2023 adjustment, and these old debts from the coronavirus pandemic are included in the public debt, which is another source that we don’t have.

Congress approved this obligation in the development plan and included it in the state budget in December. Since there was no room for implementation then, it is time again this year.

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The Ministry of Health can issue a payment resolution, but the money is not here because it is a public debt, it is in the Treasury. We are waiting for the transfer of that portfolio to arrive.

Does this reform retain the tariff manual?

The purpose of this reform is to create a single tariff manual in the system. The Ministry has been working with clinics and hospitals to adjust this manual. I don’t know the details because in this version of the system we don’t have competition on rates. In the next step, with the reform, we can have competition on rates.

What reforms will they propose?

That was a lot of negotiation with the EPS. But the negotiation was about the functions and responsibilities of each agent. That was an interesting exercise to negotiate with them. They wanted clarity on the role of the managers, and I think there was a lot of progress on that front.

These components are the same as those proposed and passed by the House of Representatives, without much modification. The principle is the same, turning the EPS into a manager that manages services but not funds. The spread of primary care, because the country is lagging behind and neglected in this regard, and the expansion of the health care network.

Today, EPS are autonomous. They will not have this power, they will only respond. The service network will be wider and will no longer be defined by the managers alone, but by the territorial governments.

There is no difference between contribution and subsidy, there is only one. The difference is whether you are obliged to pay. But not in terms of services, there will be no difference.

Where do they fund basic sanitation?

What the government is doing is funding the UPC through another means. But what has to happen in the future is that these teams become part of primary care, global financing, and have to come under primary care centers. Right now it is developing loosely, but with the reforms it is proposed as an integral part of primary care.

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What is the straight spin balance?

Direct transfers do not have the purpose of paying off debt. The money does not accumulate as an investment portfolio. Instead, it prevents debt from growing. There are also greater benefits, such as eliminating uncertainty in obtaining resources from hospitals and clinics.

An entity needs to have a fixed monthly income to operate and in the absence of a mandatory system, a system of monthly payments was created which gave peace of mind to many IPs. However, if they transfer less or order less, it is not the fault of the Adres but a problem they report to the EPS.

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What are the plans for SOAT?

We are developing a strategy to identify “ghost” vehicles. $40 billion has been paid for this concept to reduce traffic police injuries. We have many irregularities in billing, like the management of ambulances in the country. In addition, we have found 53 agencies that apparently do not exist. We are organizing these Soat topics.

Diana K. Rodriguez T.
Portfolio Reporter