Liquidating Savia would collapse the Antioquia health system

Savia Salud, the second EPS with the largest number of affiliates in Antioquia, has been walking the cornice for five years since it entered special surveillance in Supersalud due to its financial crisis.

Last June, following a long push and pull between its partners, it had managed to put together a capitalization plan for $120,000 million with which they believed it would be possible to overcome their crisis. However, today they fear that in the next few days the news of the liquidation will arrive.

The fear arose following the liquidation last week of Convida, a public EPS belonging to the Government of Cundinamarca, as it did not meet any of the three fundamental requirements: minimum capital solvency, adequate equity and investment regime.

The risk of suffering the same fate, added to the uncertainty that has arisen from the announcements and reform proposals of the Petro Government, set off alarms in Savia.

Precisely the Minister of Health, Carolina Corcho, came out yesterday –with figures and long explanations– to the comments that allude to an alleged interest of her Ministry in undermining the current system to undertake reforms.

Corcho clarified that, contrary to what has been said by some sectors regarding the alleged underfunding of health, in the two proposals of the Government the resources for insurance and for the attention of the families of the subsidized regime are increased.

But what she and the Superintendent of Health, Ulahi Beltrán López, did ratify is in the critical state of the EPS and their conviction of being blunt with the technical, scientific, financial and legal demands of these entities.

Beltrán showed the situation of the 10 EPS under special surveillance that add accounts payable for more than $4.7 billion. Among these is Savia, with 1,666,262 affiliates and accounts payable for more than $653,000 million. According to Super, Savia fails to meet the three requirements: it does not have minimum capital, adequate equity, or an investment regime.

What Beltrán said is that these entities are going to have to demonstrate important changes in their operation or else they will have to be liquidated.

And precisely what Savia wants to show, according to its manager Lina Bustamante, is that they are heading towards those changes. The problem is that until now neither the Super nor the Ministry have listened to them.

The risk of the domino effect

Bustamante highlights that since June they presented the capitalization and reorganization plan of the entity to the Super.

Savia has a capital shortfall of minus $560,000 million. As part of the capitalization, the Governor’s Office promised to put $40,000 million; Comfama, $4,000 million; hospitals $40,000 million and the rest corresponds to private providers. This is the first phase to capitalize on 50% of that equity defect and come out on top. The Super had to give its approval but with the change of Government the process has been delayed.

Bustamante points out that in addition to a viable financial proposal, Savia also has results to show in health and that are compatible with the model proposed by the Petro government, such as the articulation with providers to reach the inhabitants of dispersed rural areas and care routes and prevention together with public hospitals.

However, the manager states that it is a mistake to point all the sources of the current model’s problems at the EPS. What she explains is that if the situation of many EPS of the subsidized regimen that do not comply with the health indicators or are under special surveillance is reviewed in detail, it will be found that they depend on the response of public providers.

“We have sat down with Aesa putting on the table issues that concern us a lot: maternal mortality, controls of patients with hypertension and diabetes. To a large extent we depend on the public network. There are issues in which they have assumed responsibility and others that are a community responsibility, ”she points out.

There is a case that illustrates Bustamante’s position. A mother in a municipality who came for her first control at 34 weeks pregnant. She was not affiliated with the system; she was affiliated with Savia, she was treated but she later died from complications that had to be noticed early in the pregnancy.

What the manager intends to point out is that the capacities of the health secretariats and public hospitals intervene in the fulfillment of the health indicators, so it is inaccurate to hold only the EPS responsible and counterproductive to liquidate those that, like Savia, try to add to departmental systems.

Next Tuesday, September 27, Savia’s special surveillance measure expires. If the Super decides to liquidate it, it would unleash, according to Bustamante, a chain effect since 72% of the network in Antioquia is public and many hospitals such as the General, the University IPS, the departmental and municipal ones are “sap dependents.”

Patient migration would be another problem. According to Bustamante’s estimates, Sura would be the EPS where at least half of Savia’s users would land, which might overwhelm its capacity and would also force it to capitalize close to $64,000 million.

Concerned regarding the effects it would have on the department, Governor Aníbal Gaviria asked for a space with Minister Corcho. Lina Bustamante says that she hopes to be able to meet with the superintendent, something that they have sought insistently and have not achieved, to find a way out that really helps.