Bogotá D.C., June 29, 2022. The General System of Health Care Social Security has been consolidating in structural fronts, at the end of the current Government, for the benefit of the Colombian population. This is the case of insurance, out-of-pocket expenses, opportunity in access to medicines and health technologies, and health care for migrants.
The minister of Health and Social Protection, Fernando Ruiz, pointed out that in relation to the health insurance model, "Colombia is one of the countries in the world today with the lowest out-of-pocket spending. Also thanks to this structure, it was possible to guarantee health care to all those who required it during the pandemic. Our system is surely the most progressive and with the best guarantee of coverage in Latin America."
Next, the deputy minister of Social Protection, María Andrea Godoy, in the Public Hearing on Accountability for the period 2021-2022, pointed out that "today Colombia is reaching 99.6% of universal insurance coverage, with 24,399,839 people in the Contributive System and 24,745,934 in the Subsidized."
This progress is the outcome of mechanisms such as Assets for the Emergency, which delivered benefits to 1,892,809 people as of May 2022, where $2.41 trillion have been allotted. Likewise, for temporary economic compensation of the subsidized system, as of May, $90.9 billion have been dispensed to 430,313 family groups. Other actions include the solidarity contribution and enrollment by trade.
This insurance is supplemented by the significant efforts made to guarantee the Health Benefits Plan to include new services and technologies financed by the Capitation Payment Unit (UPC), going from 86.6% to 97%. In the case of medicines, it went from 44.7% in 2020 to 89.9% in 2021; and 93.6% if this involves medicines with conditional financing.
In addition, health spending (GTS) as a percentage of GDP has shown a growing trend since 2000 when it stood at 5.31% and by 2021, it reached close to 8%.
"The estimated GTS for the last three terms amounts to $81.8 trillion in 2019, $82 trillion in 2020 and about $89 trillion in 2021 without including FOME spending," said the official. And she added that health spending per capita has increased in the last 4 years by about 12%.
Sector financing
By 2022, the budget for insurance and other programs is projected to be close to $73 trillion, 53% from the General Budget of the Nation, and 36% from contributions. Otoniel Cabrera, director of Sectorial Financing, pointed out that the aim is to execute 50% of the budget in the contributory system and 42% in the subsidized system.
On the other hand, regarding public spending as a percentage of GDP, Cabrera specified that the estimated public spending for 2021 corresponds to 75% ($66.7 trillion pesos) compared to health spending of $89 trillion. "In terms of GDP, public spending has averaged 5.8% over the last 4 years," he added.
Regarding out-of-pocket spending, the minister of health indicated that Colombia continues to have one of the lowest in the region and in the world, which means that a Colombian has extremely little or no spending when consulting health services.
Attention to migrants
Concerning the migrant population, after President Iván Duque's decision to award temporary migration status to Venezuelans residing in Colombia, the Ministry of Health began the analysis that led to the humanitarian and integrating decision to enroll all migrants, which is unprecedented in the world.
"This has allowed us to have covered, so far, the health of 738,349 migrants and the resources have already been appropriated to reach 945,169 by the end of 2022," completed Iván Mesa, director of Health Assurance.
Likewise, in attention to migrants, during 2018 to 2021, resources for $580.4 billion have been assigned to territorial entities for the recognition and payment of emergencies of the non-regularized migrant population.
Financial sustainability
The government of President Iván Duque received an unviable health system, with chronic underfinancing of the sector where unfunded service accounts had not been paid or forwarded to territorial entities, generating outrageous portfolios.
This situation required the adoption of one of the most revolutionary policies in the health sector: the Final Point Agreement. This was an exercise that involved disclosure and auditing of accounts by the entire system and each of the country's provinces.
The deputy minister of Health pointed out that, after four years of progress, accounts for 14 trillion pesos were reviewed by the ADRES, of which 9 trillion pesos have been transferred. "Of the approved resources, $6.8 trillion of extraordinary resources have been transferred to the system; of these, $5.3 trillion have been transferred to 1,642 providers and $1.1 trillion to 33 EPSs," explained the deputy minister.
Likewise, between the periods 2019 to 2021, debts worth $1.83 trillion have been recognized in the Territorial End Point Agreement, of which the Nation has co-financed $1.13 trillion and the territories have paid $699.8 billion. "Also, debts to 35 EPSs, 631 IPSs and 170 Providers have been cleared directly for a value of $1.32 trillion," said Godoy.
In other data, it was reported that during 2019 to 2021 resources for $321.6 billion were made available. Of these, 75 IPSs were beneficiaries with credits for $201.6 billion with four EPSs (Coosalud, Coomeva, Compensar, Mutual Ser) and disbursements for $120 billion sent directly to 134 IPSs.
For the 2022 term, through Findeter, a line of credit with a compensated rate for the health sector was approved in an amount of $172,7 billion, which was allotted to working capital, debt substitution and investment of the IPSs and EPSs, and it will increase $300,000 million.
In portfolio purchase, resources worth $487.4 billion were distributed, of which $79.9 billion were transferred in 2018, benefiting 10 EPSs and 88 IPSs; and $407.5 billion in the purchase of the exceptional portfolio of 2020 in the framework of the health emergency that benefited 11 EPSs and 337 IPSs.
Health security
Colombia presented important advances in the search for the production of medicines and other health technologies, in order to guarantee the country's health security in preparation for future health emergencies.
Leonardo Arregocés, director of Medicines and Health Technologies, indicated that "we will prepare a CONPES document with a policy based on four pillars that will lead the country in the direction of the local production of a greater number of vaccines, biological agents, medicines and medical devices that will support rapid and effective response to new emergencies."
And he added that, as a Ministry, "we are going to promote the industrial capacities for the production of medicines, vaccines, medical devices and other strategic technologies. For this we must develop human resources at a technical and professional level for large-scale production and for research and development."
In addition, Arregocés noted, two private companies have expressed interest in establishing themselves in Colombia to produce vaccines. VaxThera, a national capital company that shares the goal of having the country better prepared for future emergencies; and the Chinese company SINOVAC, which has also shown interest in establishing itself in the country and is advancing in the selection of land for the construction of a plant for fill and finish, and subsequently produce the antigen.
In closing, the director of Medicines indicated that the regulation of prices for medicines continues. "These presentations had an average price decrease of 44% and in some cases up to 97%. We estimate that the savings would be around COP 217 billion," he said.
Video of Health and Social Protection, Fernando Ruiz. Closing.
