In the last 6 years, the accumulated reports of all the EPS show that revenues are growing, which is logical because the user payments made by the system are growing, but the profits are decreasing or they are directly lost. Between 2017 and 2022, the EPS only had a profit in 2020, for 585,000 million pesos. In 2021 the loss was 510,000 million and in September 2022 (last available figure), the accumulated loss for the year was 1.2 trillion.
Carmen Eugenia Dávila, today executive director of Gestarsalud, but who has also been Vice Minister of Health and was one of the officials who was in charge of creating ADRES, the great health bank in the country, explained in simple terms why this phenomenon occurs . “This is given by the variables of frequency and cost of services. In 2020 people stopped attending the doctor due to isolation restrictions, but once normality resumed, the negative trend of recent years resumed,” Dávila explained.
On the other hand, this report demonstrates a thesis that several representatives of the EPS have recently expressed. When looking at the figures as of September 2022, comparing the behavior of companies for PBS care (that is, everything included in the Basic Health Plan) and the figures for care that is outside the PBS (which are treatments and procedures for more complex diseases), it can be concluded that what the EPS earn from the UPC, they lose due to the debts generated by the maximum budgets.
Regarding the above, a clear example is that Nueva EPS has a gross utility per user 10 times greater than companies such as Sanitas or SURA and 5 earns 5 times more than Salud Total, by providing basic care. But, at the costs of what’s outside of PBS, Nueva has the largest loss in the system 634 billion. These figures, according to analysts, show that companies with a low accident rate make profits, but when it is necessary to treat the most serious health problems, losses are recorded.
“In theory, an EPS should not lose in this relationship between what is covered by the Benefit Plan and what is outside. In all these cases equilibrium should be reached, therefore, the State must review the variables that determine the cost of health. There are aspects that are beyond the control of the EPS, such as inflation and devaluation that are decisive in the value of the services”, indicated Dávila.
In conclusion, on the recent figures of the system it is necessary to Losing EPS rose from -228 billion to -921.4 billion in the first to third quarters of last year. Those who win fell in their profits from 119,800 to 56,900 million. The sector has a loss per user of 27,000 pesos. Those who win, earn 12,000 per person. Those who lose, 61,700. Those with more users with complex diseases lose more.
