A backlash against the Colombian government’s proposed health care overhaul is steadily gaining momentum among Colombia’s scientists and doctors.
“We’re not against these reforms as a whole, but certain points within them are absolutely counter-productive,” said Dr. Felipe Palacio, a pediatrician currently waging a public relations war against the proposed reforms. “The reforms are essentially asking more patients to go into debt to afford their health care.”
Colombia’s state-run national health system, known as POS, was created in 1993, and currently covers approximately 39 million Colombians. Colombia reportedly spends 8% of its gross domestic product on health care fees, a number just 2% below what France and Germany spend on health care. Ballooning costs led the government to declare a “social emergency” last December and issue 15 presidential decrees that hope to remedy a $2 million deficit.
But will the government’s plan for a cure turn out worse than the disease? President of the National Medical Academy Gustavo Malagon seems to think so, calling the decrees “a threat against the very profession of medicine, a threat that never should have been approved in this or any other democracy.”
Colombia’s national scientific association echoed the statement. “These decrees violate citizens’ basic right to health care, threaten the autonomy of medical professionals, and puts both the quality and security of medical attention at risk,” said the group’s president, Javier Perez last Sunday.
Dr. Palacio has expressed his unease with the proposed reforms through a personal blog and a facebook group, which has attracted 11,000 new members a day since its creation. The group now has close to 111,000 members in total, and Palacio is helping organize a national march against the reforms on Saturday, February 6.
Doctors and scientists have criticized the government’s decision to bypass Congress and issue the reforms through presidential decree. But as signaled by Palacio, much of the ill-feeling towards the administration’s “emergency” plan is directed towards two decrees in particular: decree 128 and decree 131.
Decree 128 states that the POS will not provide benefits for “exceptional” cases, and that a technical committee will examine which cases should be declared so. A patient declared ineligible for POS coverage should then use bank loans, pension funds or personal savings to cover health costs, the decree says. A special fund will be created to provide coverage for those living in severe poverty.
“It is essentially attempting to define which illnesses can be covered by POS and which ones can’t,” Palacio told Colombia Reports. “And those patients who are seeking treatment or medication that isn’t covered by the POS will have to pay out of their own pocket.”
According to Palacio, right now the average Colombian citizen only devotes about 19% of his salary towards health care expenses. Under decree 128, this could balloon to 50%.
“In a society where two thirds of the population is living at or below the poverty line, this spells economic disaster for the country’s development,” said Palacio.
The bigger problem, says Palacio, is that the government has been distressingly vague about which cases should be declared “exceptional.” While Minister of Social Security Diego Palacio has said that patients with “catastrophic” illnesses will not be left out in the cold, it is unknown what criteria a technical committee would use to classify patients as eligible for POS coverage or not.
Decree 131 would fine doctors up to approximately $13,000 for prescribing medication or practicing medical and surgical procedures that are not covered by POS. Monday night, the government appeared to concede to doctors’ anxieties that this would severely compromise their medical practice, and told the National Medical Academy that doctors would not be fined.
If the government hadn’t backed down, Palacio said, a pediatrician like himself would have been hesitant to prescribe costly yet effective procedures that save patients’ lives, such as one treatment for pulmonary hypertension in infants which is not covered by POS.
“The cost of this procedure can run up to 20 million pesos [about $10,160], but it’s scientifically proven that it’s the best treatment for infants with this condition,” he said. “Yet I’d be afraid to prescribe it knowing there is a risk that I could be fined.”
President of the National Medical Academy Gustavo Galegon said that the government’s reversal on decree 131 meant that doctors found performing unnecessary tests or surgical treatments not covered by POS would face other penalties besides fines, such as temporary suspension from practicing medicine.
The government’s push to rehaul inefficiencies and abuses within POS is part of a wider effort to control medical costs while facing a serious fiscal deficit. A new tax on cigarettes, beer and gambling is one such measure. The government has argued that the 15 presidential decrees are other necessary measures needed to reign in malpracticing doctors who drive up costs.
One major expense are doctors and patients who fund plastic surgery procedures through the public health system, even though such operations are not covered by POS. Other problems include doctors who either prescribe out-of-date medication, or else over-treat patients by prescribing unnecessary procedures in exchange for benefits from pharmaceutical or medical technology companies. Such benefits may include debit cards or free trips to international medical conferences, Semana has noted.
Palacio argues that the key to overhauling POS is not necessarily through the presidential decrees, but by empowering already existing organizations meant to regulate malpractice and corruption.
“There have been people who have used the system badly,” Palacio told Colombia Reports. “But the government is pretending that the majority of people are misusing POS funds for plastic surgery. The majority of people are using the POS for things that the POS is supposed to cover, but isn’t.”
When patients go to court asking the government to apply POS funding in a timely manner (a practice known as “tutelas”), 70% of those cases involve treatments that are indeed covered by POS, Palacio said.
“Even the things that the POS is supposed to cover, it’s not covering,” he said. “We need vigilance organizations to do their job, and we need the government to do its job and reevaluate and regulate POS like it’s supposed to do.”
The debate will continue as the administration continues to seek support from a thus far resistant scientific and medical community. The government will hold multiple meetings with both scientists and doctors this week, revising a complex labyrinth of reforms that, for now, appear to be keeping an ailing POS on life support.