Exactly one week ago, Colombia learned the first unfiltered text of the health reform. Since then, EPS, laboratory associations, businessmen and civil society actors have spoken regarding an accurate proposal. There are agreements and disagreements in general.
Now, the most recent intervention comes from those who can be considered the ‘heavyweights’ of the sector: National Academy of Medicine, Colombian Association of Scientific Societies, Colombian Association of Interns and Residents, Colombian Medical College, Medical College of Antioquia, Medical College of Cundinamarca and Bogotá, National Association of Health Professionals, Colombian Society of Anesthesiology and Resuscitation, Colombian Medical Union Association, Colombian Federation of Medical Unions, Colombian Dental Federation and the Colombian Medical Student Association.
These associations, a total of 12, in addition to being the voices of academics and those who work in the health sector, are part of the “Fundamental Agreements for the full development of Statutory Law 1751 of 2015”.
“1. After almost 30 years of the approval of Law 100, the current General System of Social Security in Health (SGSSS) needs a Reform that allows progress in the effective enjoyment of this fundamental right, as established by the Statutory Health Law (LES) 1751 of 2015, which we consider as the central axis for the development of any reform; In this context, the SGSSS and everything that the State provides to materialize the right to health, must be incorporated into the National Health System”, they explained in the statement to public opinion.
2. Accordingly, PL 339, raises the need to strengthen Comprehensive Primary Health Care (APIS) and positive actions to intervene in the social determinants of health.
3. We share the strengthening of the public network of health services, as well as the need to provide a solution to inequities, especially in areas with dispersed populations (art. 24 LES).
4. We welcome the conformation of the National Health Council, although we consider that to be more operational it should have a smaller number of advisors and that its conformation be re-evaluated; likewise, the creation and implementation of the Single Integrated Public Health Information System in compliance with Art. 19 of the LES, as well as the strengthening of citizen participation (Art. 12 of the LES).
5. We agree on the demand for the autonomy of health professionals (Art. 17 of the LES), the strengthening of Superhealth and the development of public policies for the training of human talent, seeking their labor formalization and the improvement of dignified and fair living and working conditions (Art. 18 of the LES).
6. However, we arise Concerns regarding risks in the operation of the new Health System to guarantee the right to health, which we allow ourselves to list:
a) Proliferation of entities with overlapping functions: 3 new national entities, plus the strengthening of 3 existing ones, 21 regional entities, added to 6 entities for each territory (more than 60) that must contract with the IPS, audit, review of accounts and flow of resources, in addition to other multiple activities, for which We not only warn of a collision of powers, but also a risk of ineffectiveness, a risk of regional political co-optation and diversion of resources.
b) Although we believe that ADRES should universalize direct transfer to providers, we believe that This entity does not have the technical capacity, nor does it have the expertise to assume new functions, in addition to some of the activities carried out by the current EPS, which would affect the provision of the service and, therefore, the fundamental right to health.
c) With the proposal to create seven different networks without evidence of integration between them in the territories, there is a risk of fragmentation, new barriers to access and impact on the comprehensiveness of care.
d) It is not clear how the resources, both financial and human talent, will be obtained that will be required for the start-up of more than 2,500 primary care centers (CAPIRS) that are proposed to be adapted or built, plus the constitution and start-up of regarding 20,000 interdisciplinary medical teams.
e) Physicians and other health professions in compulsory social service are insufficient to cover the needs of the EMIT proposed. In addition, for those who are in the process of training as specialists, their displacement to peripheral areas for this purpose does not meet the objectives of the national system of medical residences and university autonomy, given that training practices in places without infrastructure, or teaching supervision, do not they are convenient; neither are the academic, remuneration, well-being and security conditions explained.
f) Although it is proposed to formalize workers in the operational (42,784) and support (85,859) categories, starting by levels of care, at an estimated cost of $9 billion for the first 4 years, The sources for the sustainability of such incorporation in the long term are not specified.
g) The Constitutional Court, in its judgment C-756 of 2008, established that the regulation of the essential core of the rights to practice the profession and the work of health professionals must be a matter of statutory law, Article 130 of PL 339, which has been presented as an ordinary law, establishes the recertification of health workers as mandatory.
(h) Article 134, proposes medical self-regulation committees in the IPS, which include other professionals, committees on financial issues, and others, violating the very principle of self-regulation, which should be by professional peers.
i) We warn that the criminal and disciplinary sanctions, enunciated in chapter XVII of the PL, in addition to lacking unity of matter, ignore the current and valid instances for ethical-disciplinary processes for health professionals.
7. Article 150 of PL 339, subjects all of the above, that is, the right to health of all residents in Colombia, to budgetary availability and to the medium and long-term fiscal framework, ignoring the provisions of paragraph of article 334 of the Political Constitution: “Under no circumstances, any authority of an administrative, legislative or judicial nature, may invoke fiscal sustainability to undermine fundamental rights, restrict their scope or deny their effective protection.”
8. Finally, we point out that:
a) New definitions of health are established that do not fit with global scientific evidence.
c) There is evidence of a discouragement for independent workers with the ability to pay that harms the System: As there is no affiliation, there is no motivation for the independent worker, wealthy or not, to pay for health, if they can enroll anyway to a CAPIRS and becomes entitled to the Plan of Benefits.
d) There are no total figures for the resources that the System will require in the coming years, including a financial plan that defines sources and guarantees sustainability.
e) If the extraordinary powers requested in article 151 of the PL are approved, their destination should be more precisely defined, and precise guidelines and limits established, so that it is not interpreted as a “carte blanche” that substitutes the legislative power of Congress and the regulatory power of the MSPS.
Considering that literal A, of article 152 of the Political Constitution, indicates that it will be subject to regulation through statutory law, that which corresponds to the fundamental rights and duties of people and the procedures and resources for their protection, is considered essential that a prior and in-depth analysis of the nature of the project be exhausted, in order to avoid formal errors that compromise the viability of the initiative”.
Finally, they concluded in the statement that following this debate, as representatives of the doctors and health professionals, they reiterate the will to contribute experience and knowledge so that the country, with a sense of social convenience and progressiveness, respecting the fundamental right to health, building on what has been built, achieves the best possible Health System, in accordance with our conditions of economic development , political and social.
