Beyond the scandals: Colombia’s presidential candidates on health care

Ongoing crises in Colombia’s health care system has been a central topic for many Colombian voters. Candidates vying for the presidency on Sunday agree that the current system must change but cannot agree how.

The current system has been criticized for ongoing corruption, high costs and lack of coverage. Some presidential candidates believe the problem is financial and regulatory while others believe the problem is with the health care model.

Law 100 established in 1993 outlines how the health system is run and allows the participation of the private sector in the form of the controversial health care intermediaries called EPS’s.

There are currently 72 EPS’s in the country covering 96% of Colombians. However, according to a report by Colombia’s Ombudsman, 36% of healthcare costs are due to treatments and drugs not covered by a patient’s EPS. Highlighting the inefficiency of the system, 70% of EPS appeals are over treatments that should be covered under a patient’s plan.

A key topic for voters are the effects of free trade agreements — specifically intellectual property rights on medication and drug costs — on the country’s health care system.

Another pervasive problem in Colombia is the lack of specialists outside of the urban centers. If rural patients need a specialist, they must travel to a nearby city without the guarantee of being able to be seen by the specialist due to their high demand.

How will each candidate address these issues if elected president?

Juan Manuel Santos (U Party — Partido de la U)

Incumbent President Juan Manuel Santos is running for a second term and claims to have saved the current system from imploding. Santos’ administration has invested $7.5 billion to save hospitals from closing.

He also has introduced a new method to control the cost of medication using international references to compare the price on the international market to the price they are being sold at. This new method has saved $200 million, according to Santos in a interview with El Tiempo newspaper.

Santos attempted to pass a healthcare reform bill last year but ultimately failed.

MORE: Colombia health reform: The big issues

Santos proposes the following for health care:

• Increase scholarships to medical students that study specializations in high demand.
• Redesign the process with universities and hospitals of producing specialists.
• Increase the power of the Superintendent of Industry and Commerce to keep regulating and sanctioning those who abuse and counterfeit drugs and medications.
• Increase funding and create a fund to address the liquidity problems of hospitals.
• Shut down any EPS that does not provide quality service.
• Less bureaucracy.

Clara Lopez (Democratic Pole — Polo Democratico)

Leftist opposition candidate Clara Lopez has proposed the most extensive changes to the health system. If president, Lopez will completely get rid of Law 100 and put the healthcare system in the hands of the state.

The socialist candidate believes that the financial intermediary role of the EPS has no place in healthcare. In a debate she declared that “Law 100 disintegrates the holistic approach health care should have, by not taking into account the socio-economic conditions of the patients and their access to clean water, quality food, and clean environments.”

Prevention would be the focal point of Lopez’s new health care system. According to her, prevention has been neglected by EPS’s because of their for-profit nature.

Clara Lopez proposes the following for the health care system:

• Get rid of the 1993 Law 100 that introduced the EPS’s.
• Centralize resources and make health care a public service.
• Rigorous medication price control.
• Renegotiate the intellectual property clauses in trade agreements.
• Offer free Rotavirus and Pneumococcal vaccine to combat diseases responsible for most children and elderly deaths in Colombia.
• Incorporate effective traditional native medicine into the health care system.
• Establish guarantees and work with university curricula to reflect new values of health care system.

Oscar Ivan Zuluaga (Democratic Center — Centro Democratico)

The candidate for the former President Alvaro Uribe’s Democratic Center party, Oscar Ivan Zuluaga, was a leader of “Nueva EPS” and continues to support the role of the controversial intermediaries in the healthcare system.

Zuluaga would shut down a number of EPS’s which he says probably don’t provide quality service and attempt to make public institutions shareholders of private EPS’s to have more say in company administration.

The conservative candidate would additionally like to see prevention as a healthcare priority.

Zuluaga proposes the following the health care:

• Allow patients to be attended in any clinic or hospital regardless of intermediary.
• Establish a standard benefits package.
• Bring financial stability to EPS’s.
• Increase doctors’ salaries.
• Increase the number of specialists.
• Have the Superintendent of Health evaluate all EPS’s and close the ones of poor quality.
• Government imports of needed medication as allowed by bilateral trade pacts.

Enrique Peñalosa (Green Alliance — Alianza Verde)

The Green Party candidate, Enrique Peñalosa, believes stricter government regulation of the current system is key to improving quality of service and access.

One of Peñalosa’s biggest worries is the financial deficit that the current health system is functioning at, while proposing to open more public hospitals and train more doctors. The centrist presidential hopeful hopes to solve the financial problems by promoting public-private partnerships.

Peñalosa’s biggest proposal is to divide health care into three tiers. The first tier will be managed primarily by the private sector in state capitals and large cities. The second tier is in cities with populations between 50,000 and 300,000 people and will have mixed participation of both the public and private sector. The third tier will be in towns and municipalities with less than 50,000 and well be managed by the state since it is not profitable for the private sector.

Peñalosa proposes the following for health care:

• Empower the Superintendent of Industry and Commerce to regulate the prices of drugs and medications.
• Increase the number of public hospitals.
• Increase the number of specialists in medium and small cities.
• Introduce more technology in healthcare via telephone appointments, a health channel, and an electronic health database.
• Stop the closing of public hospitals.

Marta Lucia Ramirez (Conservative Party — Partido Conservador)

Conservative Party candidate Marta Lucia Ramirez has various aesthetic proposals concerning the health system.

Ramirez says the health care system has been robbed and no longer is centered around the patient. Her proposals are meant to enhance vigilance, respect the “free market” while preventing monopolies.

The Conservative wants to increase supervision to ensure state funds given to EPS’s are used to provide medical services, and not to “make investments in foreign countries as has been previously reported,” Ramirez said in a presidential debate.

The  proposes the following to improve health care:

• Create a standard benefits package for all Colombians.
• Government imports of needed medications as allowed by trade pacts.
• Strengthen watchdog agencies.
• Send the best doctors to different regions.
• Increase doctors’ salaries.

 Sources

• Clara Lopez (Campaign Website)
• Enrique Peñalosa (Campaign Website)
• Juan Manuel Santos (Campaign Website)
• Martha Lucia Ramirez (Campaign Website)
• Oscar Ivan Zuluaga (Campaign Website)
• Más Allá De Los Escándalos, Esto Proponen Los Candidatos (La Silla Vacia)
• Cada mes se instauran 9.500 tutelas invocando derecho a la salud (Vanguardia)
• Las propuestas de los cinco candidatos presidenciales sobre salud (El Tiempo)
• U de A debate presidencial (youtube)
• Ley 100 de 1993 (Senate Secretary)