THE GREAT TRANSFORMATION OF THE HEALTH SYSTEM IN 2020
There is a very powerful change, which calls us to review the way in which we structure the financing of the different baskets of services to which we Colombians are entitled.
The news that is currently making headlines is the pandemic, with its four waves and the high sectoral, social and institutional costs that it leaves us; But beyond that, there is a very powerful change, which calls us to review the way in which we structure the financing of the different baskets of services to which Colombians are entitled, and the relationships between the different stakeholders, and we are talking, of course, yes , of the start-up of the mechanism called Maximum PM Budgets.
ORIGIN OF THE TRANSFORMATION
During 2018 and a good part of 2019, the government and the governmental institutions had well-founded doubts about the economic sustainability of the health system, a reason that prompted the inclusion of two mechanisms within the National Development Plan (Law 1955 of 2019) that They aimed to resolve this risk in the background: the first so-called "end point" that found debts in charge of the State for about $ 6.7 billion, and of which $ 1.5 billion have already been paid; and the topic that does not occupy today, the "Maximum Budgets - PM" defined in resolutions 205 and 206 of 2020.
HOW'S THE END POINT GOING?
As we have already said, during 2019 around $ 1.5 billion were turned over, among whose payments the following stand out:
$ 514 billion owed by Caprecom
$ 172 billion transverse gloss
$ 349 billion in advance payment adjusted to IPS
$ 220 billion prepayment adjusted to EPS
VERIFICATION PROCESS RECOGNITION AND PAYMENT OF THE END POINT
Making it clear that the government's commitment is still far from being fully fulfilled, it is no less true that the institutional gallantry that involves a gigantic international public debt to meet the obligation is very well seen, and urgently required.
To advance the process, ADRES, through Resolution 2707 of 2020, adopted the Operational and Audit Manual, which describes the stages and steps that must be carried out to organize, present, review and verify, validate, recognize and pay for services and health technologies not funded by the UPC.
The other norms that frame the participation of the actors that would benefit (providers, OL, suppliers, pharmaceutical industry and EPS) are:
Circular 025 of 2020 - Schedule
Resolution 618 of 2020 issued by the Ministry of Health and Social Protection,
Decree 521 of 2020
Decree 800 of 2020
THE MAXIMUM BUDGETS
Article 240 of the aforementioned Law 1955 of 2019 (PND), encompasses the concept of Maximum Budgets -PM within a financial line called spending efficiency .
Already this surname, distances us from results and qualities that the sector would quickly demand, but it would put us on the other hand, in tune with the true sector transformation: the centralization of the resources of the health sector, and its integral management in charge of the EPS.
The simplicity of the methodological design is perhaps its best argument: a national collection of data from the MIPRES tool and the operation of the territorial entities, to establish a baseline of patients / users, technologies used (quantities) and their standardization based on minimum units of contraction of relevant groups and projections of uses for the next two years, which made the emergence of a delta indispensable (which would cover the risk inherent to mathematical suspicion); finally the incorporation of the VMR - Maximum Recovery / Collection Values, which would establish the purchasing power of this ceiling.
The result was a technical regulation for coverage by the PMs, and a resource allocation table that totaled $ 3.9 billion for ten months of operation, distributed in unequal parts between EPS of the contributory regime ($ 3.3 billion), and EPS of the subsidized regime. ($ 594 billion).
It is worth clarifying here that the subsidized insurance with cut-off to June 2019 covers 24,307,637 people (it grew by 1.5 million people in 6 months), while the contributory scheme enrolls 22,065,702 Colombians (it decreased somewhat more of 900 thousand people in the last 6 months).
FINANCIAL RESOURCES FROM MAXIMUM BUDGETS
This noble operation brings other unremarkable benefits so far; The first is the financing already obtained for the resources and their placement in the ADRES, which thereby achieves ample funding, and an unprecedented availability to pay for the services not financed by the UPC.
The second would undoubtedly be the correct decision to make advance transfers of these resources to payers (EPS), a situation that in a pandemic resulted in a cataract of resources that anticipated March, April and May.
The third, already titled before, is the financial concentration in the EPS that now receive, contract and pay for the services of collective protection (previously called health benefits plan or POS), and individual protection (previously called no pos or no pbs ).
The month of March 2020 will mark a before and after in the Colombian health system; the resources transferred to the EPS had never reached such heights:
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