“They had been treating us like thieves and usurpers of health resources for eight months and until that night they had never given us an appointment.” Thus begins the account of one of the attendees of what happened in the face to face of the EPS with Gustavo Petro. The tension was complete. It was not be for lowerly. The main pillar of the president’s health reform was, until this Thursday, to finish them.
But the directors of the companies were clear regarding one thing: this was not the day to fight. The Government, however, arrived in a different vein. The meeting was initiated by Minister Carolina Corcho, who welcomed them and did not speak once more. Then the floor was taken by the president, who began haughty. “He was kind, but threatening,” says another manager. The first thing he said is that he had arrived with a promise of change and that if the reform was not carried out, the Government might not contain the social explosion that would come.
Even with that lead, for the magnitude of the government’s broadside once morest the EPS, what happened this Thursday for everyone was almost miraculous. No one had ever heard Petro recognize the role that these companies have played in the country for the last 30 years, whom the government, in the best of cases, branded only as financial intermediaries. “There was no blood,” summarizes one of them.
For the presidents of the companies, the single appointment was a huge gesture. In the first place, because they had not had spaces for dialogue in the past and, secondly, because it was regarding all the first-level officials who have to do with the discussion and not only the Minister of Health, who has been dismissive with them.
President Petro came out happy to ponder the meeting in networks. “I rate the meeting with the EPS as excellent. There is a will to move to the new model. The EPS value the need to implement the preventive health and primary care model throughout Colombia,” he wrote on Twitter.
The country immediately understood that the EPS is not over. Reality has its nuances. “The meeting was excellent, but that does not mean that we support the reform, nor that we continue,” clarified another of the attendees.
The Minister of the Interior, Alfonso Prada, summarized the Government’s new thesis as follows: “The project, under no circumstances, eliminates the EPS and does not set a subsistence transition term for them either. Those who are conditioned and believe that they can coexist within the new system of prevention and primary care will have all the possibilities of developing a social purpose”.
Prada’s statements ended with two postulates that Minister Corcho had said: that the EPS were ending and that the transition period was not more than two years. But he did not explain if they continue, how they do it. “Prudence”, almost all the presidents of the companies answered regarding what happened.
The managers agreed not to make high-sounding statements because they appreciate the space that was opened with the Government. However, they do have many doubts. “EPS yes, but not like this,” says one of the presidents. For him, the core of the discussion was not clear at the meeting: whether they continue with the demonized role of insurance in the system. That, in simple terms, means that today these companies have the management of the great resources of the health system, which are approximately 70 billion pesos.
Each EPS receives on average a little more than a million pesos per year per person through what is called the UPC (Capitation Payment Unit). And with that, you have to ensure that the health service is delivered to you, even if it costs more. When that Colombian suffers from a disease that requires treatment not covered in the health plan, these costs are covered by the State, for what is called Maximum Budgets.
On the contrary, he gave them to understand that no. When he recognized the work that the EPS do on issues such as population management, disability payments and invoice auditing, he told them that in the new model they might be hired to do the same. “He proposed us to be health service providers,” explains one of the attendees. “Deep down there is no understanding of what the insurance model means and this is the axis of everything,” adds another.
“The meeting lasted almost three hours, but ten minutes were very valuable to me, in which the president said that these reference and counter-referral tasks, and accompanying the user when they move around the health institutions, are the heart of the EPS and that we were going to keep that function”, says one of the managers.
In much of the conversation they talked regarding many things on which both sides agree: that there is a lack of resources, that attention to remote territories must be improved, that the success of the system lies in promotion and prevention. And the Government offered them to continue with the so-called Primary Care Centers (CAP), perhaps one of the most controversial axes of the system, which would force Colombians to be cared for and organized by their neighborhood.
“It’s not that the CAPs anguish me because I simply didn’t understand how they intend to fit everything into this model”, asks one of the presidents. “What he told us is that we will call ourselves EPS, but we must become IPS,” warned another.
The balance, however, is less bitter than it was before. “We did leave the meeting happy, but the truth is that they did not give us many clues,” adds another. The details of how they will continue are eagerly awaited in the articles that the Government is going to file on Monday. “We are waiting to see what they file. We do not want to give an opinion without an article. There we will tell the president if we are with the reform or not”, warns one of them.
Petro’s twist was great, but not an act of nobility either. Since the reform was coming, it was practically impossible for it to be approved in Congress. His greatest opponent was Roy Barreras, president of the Senate and squire of the first president. In an interview with WEEKthe senator dispatched once morest Minister Corcho and called her arrogant.
In Ocampo’s office is the text of the reform, and it is known that without his approval it will not be presented. The Treasury and Planning review is what has prevented it from being filed in the days that Minister Corcho has announced. The text she left there is expected to come out shorn. As María Isabel Rueda revealed in her Tik Tak, beyond that, there was a triggering event.
President Petro met with the president of the Nueva EPS, who was clear in telling him that the public system was not capable of receiving all the private affiliates. That set off the alarms and opened up this new space, which today sets a different tone for the discussion.
In the health profession, however, there is a mixture of fear and hope. “Eight days ago we mightn’t even see each other in paint”, explains one of them, but adds: “What matters, however, as we have said from the beginning, is the text. Only then will we know if they finish us off or continue.”
