“National Development Plan 2022-2026: Updates, Debates, and Implications for Health Sector”

2023-05-03 03:50:00

The plenary sessions of the Chamber and Senate began voting yesterday on the project of the National Development Plan 2022-2026. The document, which has until May 7 to be approved at the latest, reached its last phase in Congress with 373 articles, a volume greater than the 300 that the initial project presented by the Government had.

(You can also read: The digital security agency falls in the Senate debate)

Yesterday the approval in the plenary sessions of Congress was around 50 percent; However, some of the most critical issues remained to be debated, such as the changes that seek to favor contracting with people from the popular economy and that have sparked a series of criticisms for possible freelance contracts or the article related to the voluntary purchase of land that opened the debate on “express expropriation”.

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In the Senate, the elimination of the new article that would once more include the health reform within the Development Plan (PND) was discussed without success. And it is that despite the fact that these issues had been eliminated in the first debate on the Government’s road map so that they did not go beyond ‘agache’, there is one that was revived and that might also be approved this week in plenary.

This is the article that says that The Adres will make the direct transfer of the resources of the Units of Payment by Capitation (UPC) of the contributory and subsidized regimesintended for the provision of health services, to the institutions and entities that provide said services and that provide technologies included in the benefit plan, as well as to the suppliers.

This means that the Adres would turn directly to the hospitals, without going through the EPS and therefore the latter would lose the financial intermediation business that they have maintained in recent years.

Although today the ADRES collects and collects the bulk of the resources of the General System of Social Security in Health (regarding 80 billion pesos) and delivers them mostly to the EPS, In the event that any of these projects are approved, they would be transferred directly to the different clinics, hospitals and other health providers.

The congressmen do not believe that it is advisable to include this article in the Development Plan. They said from the beginning that by including it in the two projects they want to camouflage this aspect of the health reform, because if it is not approved on one side they denounce that it would remain on the other.

“I don’t understand how something that is in the health reform is included in the PND. I share the direct turn, what I think is that they want to guarantee it with or without reform”, assures the representative of ‘la U’ Víctor Manuel Salcedo.

While Senator Ciro Ramírez said that an article that was already denied in the economic commissions cannot be considered once more, Miguel Uribe pointed out that it would be inconvenient because the Adres “had too much to do what it has to do.

Also a few days ago, the senator of Cambio Radical David Luna warned that putting it in the PND prevents sufficient discussion on issues that due to their importance and the debate they generate should be processed in particular laws. “Here, the Government wants to ensure the approval of high points of the health reform, such as the direct transfer of resources from the Adres to the IPS”, he sentenced.

From Acemi, the union that brings together the EPS of the contributory regime, Its president Paula Acosta stresses that Congress has asked that the reform proposals not be mixed, since they have a different nature, and says that she is concerned regarding various aspects, such as that by concentrating all payments in the Adres, an entity that “does not have the capacity necessary operational”, it can generate a greater problem of flow of resources throughout the system.

“The risk of bad practices would grow, by concentrating all the power of resource rotation in a single entity that has weak corporate governance, and information systems that are not transparent to the public,” he says.

However, other health actors agree on the advantages and the need for implement direct spin. “If the universal direct transfer is achieved, two major problems that overwhelm public and private providers are solved, so the project does aim to solve their problems,” says the director of the Colombian Association of State Social Enterprises and Hospitals Public (Acesi), Olga Zuluaga.

Carmen Eugenia Dávila, executive director of Gestarsalud, also said that direct transfer is already widely spread in the EPS of the subsidized regime. “If it is extended to the contributory, we believe that it can contribute to confidence in the proper use of resources and the improvement of the flow of resources to providers and suppliers. It is an interesting, successful figure that can be expanded, ”she said.

The new article of the Development Plan specifies that the EPS that have a good financial performance would not be subject to the provisions of this article, that is, it would apply to those that are under some surveillance measure. For example, today some are experiencing financial difficulties such as Asmet Salud, Savia Salud, Emssanar, Capresoca or Comfachocó.

“The health reform is being developed in another government proposal, so this article does not seek to replace it or advance its scope. The article seeks to strengthen the flow of resources in the health sector, a task that ADRES has already been developing to guarantee resources to providers,” said Jorge Iván González, director of the National Planning Department (DNP), a few weeks ago.

health debate

As the congressmen have to approve the Development Plan by May 7, at the moment this week the discussion of the health reform project does not appear scheduled to continue its first debate. The initiative received an affirmative vote in his presentation, but the quorum was diluted just when they were going to start discussing the articles.

This is because the parties that were previously from the government coalition (Liberal, Conservative and ‘la U’) did not reach an agreement with the Government and they gave the order that they might not support the articles proposed by the Executive. This situation was one of the causes of the ministerial crisis for which President Gustavo Petro decided to replace seven of his ministers.

Most likely, the project will be debated the week of May 8-12. Then, in plenary, it might be discussed the following week. In accordance with the fifth law, which regulates the procedure of Congress, two weeks must be waited for it to pass from one corporation to another.

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