2023-09-22 21:40:48
From January to July of this year, 816,555 complaints have been submitted to the Superintendency of Health due to the poor functioning of the EPS between the contributory and subsidized regime in the different departments of the country.
Read also: (This is how the accidental commission will work to reconcile health reform).
During the first half of 2023, there was an increase of 12% in the number of complaints, petitions and claims from citizens compared to the same period in 2022, when 717,913 cases were registered.
The departments with the highest number of claims this year have been Bogotá with 165,584, Antioquia with 124,668, Valle del Cauca with 92,403, Cundinamarca with 43,718, and Santander with 41,150. The highest rate of complaints, which reflects the frequency with which more objections are presented to the services provided by health promoters, was in Risaralda with 236 per 10,000 members, along with the country’s capital and Valle del Cauca, which are over 200 complaints.
EPS indicated by the Supersalud report
According to Supersalud reports, the EPS of the contributory regime with the most complaints are the Western Health Service (SOS), with 276 complaints per 10,000 members. And the panorama of the last period does not change, in which it also ranked first as the EPS with the highest rates of complaints for its services.
The EPS SOS focuses its functions on Valle del Cauca, Cauca, Risaralda, Caldas and Quindío, where it is most common for members to have dissatisfaction with the health system. Between the five departments they have around 21 percent of claims from the entire country.
This health promoter asked Supersalud to withdraw its operations in Bogotá and in the municipalities of Itagüí (Antioquia) and Manzanares (Caldas), where it had 2,436 members. The EPS SOS indicated that “its decision is due to the low number of members, a situation that makes it difficult to implement the care model and comprehensive networks to carry out adequate risk management for users.”
The second EPS with the highest rate of complaints is Coosalud, which is present in 12 departments in the country. In the latest statistics, it was recorded that for every 10,000 affiliates it had 242 complaints.
In the subsidized regime, Capital Salud occupies first place in the highest number of complaints filed by users, because 234 requests are registered for every 10,000 affiliates. This EPS is also recognized for providing medicinal cannabis therapies to its patients, and has a total of 1,179,039 registered in different parts of the country.
Other EPSs that have high rates per 10,000 affiliates are: Comfenalco Valle, with 212 claims; Compensate, with 206; and Nueva EPS, with 196, in the contributory regime; and Savia Salud EPS, with 181 in the subsidized one.
Capitals, the focus of nonconformity
Neiva, Bucaramanga and Pereira are the cities with the highest rates of nonconformity. Over the course of the year, compared to 2022, the unrest in the capital of Huila increased around 22 percent, and marked a record of 281 complaints per 10,000 members.
In second place is the capital of Santander, which showed a 19 percent increase in user complaints regarding health, with 272 complaints per 10,000 members. In 2022, Bucaramanga registered 220 complaints and ranked fifth among the cities with the highest frequency of filing complaints regarding the service and operations of the EPS.
The capital of Risaralda decreased 12 percent compared to the previous year, and was ranked third among the cities with the highest frequency of complaints, registering 257 complaints per 10,000 users.
Keep reading: (These are the keys to the crisis in Famisanar: what led to the intervention of the EPS?).
Delayed attention is one of the main complaints from users to EPS
Photo:
Paula Valentina Rodríguez – EL TIEMPO
The most recurring complaints to the EPS
The Supersalud report indicates that the most recurring complaints are: guarantees in access to specialist doctors and delivery of medications in a timely and rapid manner.
Over the course of the year, 214,237 complaints have been filed from people who warn of delays by the health system in assigning appointments with specialists for different pathologies, which represents 30 percent of the total requests that were made during the first semester of this year.
Other complaints that users present to health care companies are that the medications that are part of the Mandatory Health Plan (POS) are not being delivered. In the first half of 2023, 77,130 observations have been submitted, and it represents around 11 percent of the total claims.
Added to these two dissatisfactions, user inconveniences are evident regarding the delay in scheduling diagnostic exams, scheduling surgeries, and the lack of opportunity that persists in accessing second and third level imaging services.
According to the Supersalud report, 89 percent of user complaints are dissatisfied with the restrictions that persist in access to the health system in the country.
Dylan Escobar Ruiz
School of Multimedia Journalism EL TIEMPO
1695426012
#EPSs #highest #rate #claims #Colombia #Health
