A total of 85 children with cancer and other hematological illnesses in northeastern Colombia have been left without medical service after health insurance provider, Saludcoop, has failed to pay nearly $650 thousand it owes to the hospital.
The San Luis Maternal and Children’s Clinic stopped providing services to the patients this weekend due to lack of payment by the “ESP” — private institutions in Colombia that provide health insurance plans and are responsible for reimbursing hospitals for services. Saludcoop owes the clinic in northeastern city of Bucaramanga $642 thousand which has accumulated over the last two years.
According to W Radio, after repeated attempts by the clinic to settle the debt, the clinic decided to suspend services to pressure the insurance provider into providing payment.
Executive Director of the Fundación Viva, Nury Villalba, said 14 patients are actively receiving treatment by the hospital. In a public statement Villalba stated “patients cannot be hindered or prevented medical treatment because of internal procedure between health agencies…these bureaucratic processes…shouldn’t affect the protection offered by the State” as reported by Vanguardia.
Jaqueline Lizcano, a mother with a child receiving care from the clinic, confirmed to Blu Radio that “since the weekend the children’s services in the San Luis Clinic have been canceled, they are not attending to the children and have placed bars on access to emergency services”.
The clinic will no longer accept new patients affiliated with SaludCoop, a health service provider whose task is to ensure the healthcare of over 5 million people in nearly every municipality in the country according to El Tiempo.
Public Defender Kadir Crisanto Pilonieta Díaz visited the clinic this week. In a statement to the press Díaz stated, “We have determined that Saludcoop has a debt of close to 2,000 million pesos ($642 million) owed between the years 2013 and 2015. As a way to pressure payment, the clinic decided to cut services to the 85 children receiving cancer treatment affiliated with Saludcoop…We ask the clinic to stop pressuring EPS in this way as it puts in risk the patients’ lives”. The regional Public Defender left the clinic with hopes of seeing services normalized by Friday according to Blu Radio.
Sergio Prada, manager of the San Luis Clinic, told Blu Radio that, “no child has been left without cancer treatment…I don’t know where they are getting the idea that services have been suspended, I invite anyone to come verify the treatment we are giving to the children in the clinic”
Outstanding debt another black mark for EPS
Saludcoop’s outstanding debt to the San Luis Clinic is the latest in a series of mismanagement and corruption accusations brought against the health care provider. Since at least 2011 when journalists and authorities found the organization had embezzled millions of dollars, the national EPS system has been under scrutiny from national groups and leaders.
The organization has been accused of using taxpayer money to construct its own medical centers which would be considered a conflict of interest. Saludcoop, a subsidiary of EPS was convicted of fraud by a national prosecutor in 2013, two years after the government had repossessed the organization.
Saludcoop underwent intensive investigation for defrauding clients and embezzling billions of dollars in health care funds and failing to pay hospitals. This failure to pay eventually pushed dozens of health care centers around the country to the verge of bankruptcy.
In 2014, EPS was responsible for covering 96% of Colombians. Since allegations of fraud, mismanagement and corruption have surfaced, little has changed with EPS service.
In July of this year EPS was fined nearly $1 million for failing to provide adequate medical services and programs leading to the death of 12 Wayuu children in one of the nation’s harshest regions: La Guajira. The EPS companies were found responsible for the failure to provide strategies ensuring that the children had access to health services that could have saved their lives.
Late Wednesday afternoon, Saludcoop comptroller Guillermo Gross announced that an agreement between Saludcoop and the San Luis Clinic had been reached. The comptroller assured that the agreement would insure no further delay of services to the 85 children, according to Blu Radio.
Claves para entender la crisis de Saludcoop (El Tiempo)