2023-05-19 00:54:00
The EPS must become Life and Health Managers.
Photo: Oscar Perez
The Seventh Commission of the House of Representatives approved on Wednesday night a series of articles that represent some of the most key issues of the health reform project of the Government of Gustavo Petro. Among them, for example, is the fundamental article 60, which determines the functions of the Adres, the so-called health bank. There it is stipulated that this entity will assume as sole payer of the health system, a figure that confers a series of responsibilities that some people and public health experts in Colombia believe that the entity will not be able to assume efficiently with the current capacity. (You may be interested in: With the health reform, Adres, the health bank, assumes new functions)
That article states that the Adres must carry out the verifications for the recognition and payment of the services “for which purpose it must hire the corresponding audits.” It will be able to contract the Life Managers (today EPS) and other actors to carry out medical audits, a function that is vital for financial risk management and therefore, for the sustainability of the system. Today these subsequent and concurrent audit functions are fully performed by the EPS.
Article 135 is also approved, which establishes the transition from the current health system to the future (in case the project is approved). There, among other measures that seek to guarantee that Colombians do not lose access to health in this transition, it is stipulated that the EPS that meet the permanence requirements and want to remain in the system must accept a territorialization process that will be carried out by the Ministry of health. This means that the EPS will be concentrated in territories where they have the largest number of affiliates and the largest organization of services. In those where there are no EPS left, it will be the New EPS that assumes that population, an entity with mixed participation between the State and private companies. (You can also read: Invima clarifies what happened with diclofenac in Barranquilla)
Precisely, and with respect to the EPS, article 49 is approved. This section of the reform defines how these entities should be transformed into Life Managers. The two-year period is maintained as a transition time (something that the Government had insisted on and that some parties asked to increase to five years). They must submit to the transfer and direct payment of the ADRES, and present a document in which they state their intention to continue in the system. They will also have to submit a debt settlement plan with their creditors to be in peace and safe.
Article 54 is also approved, which stipulates that these Managers will receive a payment of 5% of the per capita value of the population under their care for the administrative and operational functions they perform in the system, but they may also receive an additional 3% of incentives. by results. The Managers lose with what was approved this Wednesday the ability to organize and manage the service networks, because according to articles 12, 13 and 14 (also voted positively), it will be the Ministry that will enable these networks with the support of the departmental and municipal directorates. of health that will coordinate with the CAPS and the Managers in the framework of a public-private operation.
Finally, article 10 that structures the functions of the Primary Health Care Centers (CAPS) is also approved: It stipulates that Colombians must be attached to the CAPS of their choice according to criteria of proximity and geographical accessibility of their home, among others, determined by the Ministry of Health. When they change their place of residence, they must register once more with the nearest CAPS. The CAPS will collect information on the characterization of their health territory through the territorial health teams, contribute to the execution of public health programs, provide and articulate comprehensive service networks, among others. (We recommend: Eye! This alleged “sexual enhancer” is being sold fraudulently)
This is in addition to the approval of the new functions and capacities of the Adres, the so-called health bank, which were also approved this Wednesday as we explained here.
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