ACCOUNTABILITY 2013 - MINISTRY OF HEALTH AND SOCIAL PROTECTION
1. Statutory Law for Health
In 2013, a Statutory Law in Congress was adopted, defining the right to health, establishing it as a fundamental right and instituting its protection mechanisms.
With the approval of this Law, the fundamental right to health for Colombians will now be respected, protected and guaranteed, with quality, timeliness, sustainability and equity.
The Law also provides that a Colombian accessing health services and technologies will not require any administrative authorization between the service provider and the entity that fulfills the role of service management.
It also states that health services should be fully provided, independent of the origin of the disease or health condition. The State also recognizes the financing of the social determinants of health (that is, the circumstances in which people are born, grow, live, work and age), with resources other than health funds.
The Statutory Law becomes the first law, in the 22 years of the term of the 1991 Constitution, which regulates a fundamental social and economic right.
Under this framework, in the second half of the year, the Ministry continued to work on a proposal to reform the health system through an ordinary bill, still pending in Congress.
2. Update of the Benefit Plan (Mandatory Health Plan, POS)
The commitment to update the Benefits Plan (Mandatory Health Plan, POS) every two years (2011 and 2013) was fulfilled. Thanks to comprehensive POS update, today Colombians have 350 new services and first-line treatments available. These include measures to treat cancer, HIV/AIDS, rheumatoid arthritis, cardiovascular, mental, neurological, acute diarrheal and respiratory disease. The new Benefits Plan will allow patients to have greater therapeutic options.
A strategy for public participation was used to update the 2013 Benefits Plan, specifically with the actors of the General System of Social Security in Health. With their experience, these stakeholders contributed to the design of the new Benefits Plan scheme.
3. Measures to control drug prices
In the past, price liberalization and the emergence of recoveries had led to an increase in pharmaceutical expenditure. The Colombian State was abused as it paid drugs at any cost, which ultimately threatened the sustainability of the health system.
In addition to the controls in recoveries, a methodology was first used in 2013 for the price control of monopolistic or low competition drugs. The methodology established a ceiling on wholesale prices based on prices in 17 developed and developing countries. After the release of prices, they were controlled according to market conditions and international data. The different actors in the chain must report prices and quantities traded in the SISMED Information System. Since the Fosyga knows the prices paid, it may therefore exert additional control. The Superintendency of Industry and Commerce may, in turn, impose fines if the information is not reported or if the reports are wrong or fraudulent.
With this, some $ 400 billion were saved in 2013 for the health of Colombians, with the price control measure on about 9,000 drugs.
4. Vaccination (Expanded Immunization Plan and new HPV vaccine)
We have the most complete and modern free immunization plan in Latin America that includes free vaccinations to children under one year of age. It has vaccines for the prevention of 19 diseases. In 2013, the total vaccination coverage in Colombia was 91.1% in the biological tracers (MMR and Pentavalent-DTP). On the other hand, in the same year the Ministry of Health included the Hepatitis A Vaccine in the Vaccination Scheme, benefiting 643,267 one-year-old children in 2013.
Furthermore, the results of the first phase of the free vaccination program against the Human Papillomavirus showed that approximately 352,000 girls were vaccinated with two doses, that is, 94% of schoolgirls. 85% received 3 doses. These are record figures for countries that incorporate this type of vaccine. For the cohort of 2013 (second phase), the goal achieved was 91.4% of the total 2.4 million girls coordinated by the program.
Vaccine Coverage of the Biological Tracers
Source: PAI 2010-2011-2012-2013
5. Assurance (portability, mobility, recoveries).
The system achieved 96% coverage in 2013, which is confirmation of universal health coverage. Compared with 2012, 227,640 new members have registered with the system of which 192,530 are in the contributory system and 35,110 are in the subsidized system. So far, there have been 2.7 million new members registered with the health system in this government (2010-2013).
People Registered with the System of Social Security in Health 2003-2012
In 2013 the regulation of national portability of the Social Security System in Health was adopted, in accordance with the provisions of Decree 1683 of 2013, provided as of Law 1438 of 2011. With the implementation of portability, health users can access health services in any municipality in the country.
Similarly, the Ministry issued Decree 3047 of 2013 which lays down conditions and rules for the mobility from the subsidized system to the contributory system, and vice versa, of the people registered with the General System of Social Security in Health, SISBEN Levels I and II, who, due to changes or failures in their socioeconomic conditions, must do so without changing EPS.
The Ministry of Health redesigned the recovery process. With the procedural adjustments, the Ministry fulfills one of the orders of the Bogotá Constitutional Court, August 1, 2013. Resolution 458 of 2013 of the Ministry of Health and Social Protection unified the recovery procedure before the Solidarity and Guarantee Fund (Fosyga). The regulation established the requirements and the process for payment control and verification of the recovery applications, and the terms, timing and payment of the same.
6. Measures for the flow of resources (Clearing and portfolio purchase, Direct Transfer)
Within the program of fiscal and financial clearing, the Ministry of Health allocated $ 149 billion in 2013 to provinces to support state social enterprises categorized in medium or high-risk level.
Another revolutionary step consisted in approving a portfolio purchase for $ 292 billion, based on information reported by the Health Promoting Companies (EPS), benefiting 125 Health Provider Institutions (IPS).
Also, the time of transfer of the resources of the subsidized system was reduced from 97 to just five days. Additionally, 76% of the transfers enter into hospitals directly with the implementation of the direct transfer from the nation to hospitals. Finally, the direct transfer to the IPS in 2013 reached $ 7.5 trillion. Since 2011, is has accumulated $ 12.8 trillion. All this leads to a more efficient health system.
7. Public Health (Ten-Year Plan and specific actions)
With the delivery of the 2012 – 2021 Ten-Year Public Health Plan, the roadmap was established to advance over the next decade toward the ideal of health for Colombians. This Plan was launched in March 2013 and during 2013 the Ministry of Health and Social Protection guided the implementation in the regions.
Specific actions include the recognition of Colombia in July 2013 by the World Health Organization as the first country in the world to eliminate Onchocerciasis or river blindness. Moreover, in November, WHO gave Colombia the award as a champion of the Americas by halving malaria cases in three years.
8. Victim Care Program (PAPSIVI)
In October 2013 the Ministry of Health implemented the Program for the Comprehensive Health and Psychosocial Care of Victims of Armed Conflict in Colombia - PAPSIVI. PAPSIVI guarantees the right to health and the restoration of the physical, mental and psychosocial conditions under the assistance and rehabilitation measures set forth in Law 1448 of 2011 or Victims Act, which has been a milestone for the country.
The corresponding care roadmap must be adjusted locally, adapting it to local conditions and the characteristics and situation of the victims, which will result in differential local roadmaps.
9. Clinical Practice Guidelines
25 clinical practice guidelines based on evidence were produced. The guidelines were developed by experts at the National University of Colombia, Antioquia University, Pontificia Universidad Javeriana, the National Cancer Institute and the Colombian Association of Pediatric Pulmonology. The guidelines contain topics of interest to the country such as:
10. Integrated System of Social Protection, SISPRO
In 2013, the Ministry of Health and Social Protection launched the epidemiological information module or of people, of the Integrated Information System of Social Protection (SISPRO).
The web page: http://www.sispro.gov.co/Pages/Observatorios/asis.aspx has available information, relevant for the monitoring of the Ten-Year Public Health Plan, the strategy of primary health care APS, Millenium Goals, Children and Adolescents, and the health situation analysis (ASIS) and health observatories such as: teenage pregnancy, maternal health, food security and nutrition, aging and old age, HIV - AIDS, Cancer, among others.