President Juan Manuel Santos submitted his new healthcare reform bill to Congress, a proposal that will reportedly eliminate the private insurance companies (EPS) who manage public healthcare funds.
Santos declared in front of senators on Tuesday that his new healthcare model will be “much more efficient, much more accessible and much more supportive.”
Under the proposed reforms, the group of independently run enterprises – known as Entities Promoting Healthcare (EPS) – that manage taxpayer-funded healthcare funds will cease to exist. The government will replace the EPS with a single, government-controlled fund called “Salud Mia” (My Health).
In order to replace the EPS, the government will create a number of “health consultancies,” which although won’t directly manage any health funds, will help to provide an intermediary function between the government and the people.
According to newspaper El Tiempo, the health consultancies will be in charge of ensuring healthcare to the population within the new system, defining service networks, auditing accounts and defining direct payments to healthcare institutions.
Certain existing EPS will be allowed to take on the role of health consultancy under strict regulations.
Those who oppose the suggested health plan criticized Santos for allowing existing EPS to be involved at any level in the new system.
Senator Jorge Robledo with the Polo Democratico Party told Colombia Reports that the healthcare system will see no real change because they have basically kept the same structure and changed the name.
“Who is going to manage the accounts [healthcare funds]? The EPS, not the government,” said Robledo adding that, “They’re going to be the same EPS with another name. The same people, different name.”
In 2011, EPS was at the center of a major healthcare corruption scandal that reportedly cost taxpayers $5 billion. The healthcare scam saw corrupt EPS workers deny insurance claims for patients seeking medical care, then turn around and use the paperwork to make false claims and pocket the money.
Robledo said that taxpayer money supposed to be used to provide Colombians with healthcare, will be no safer in the hands of the proposed health consultancies than it was in the hands of the corrupt EPS, basically because they will be the same people.
For his part, President Santos claims his new changes will allow the members of the system access to the medication that they need, addressing the current situation in which doctors are forced to limit their diagnoses and prescriptions to a restricted list.
The Santos government also promises better prevention and rehabilitation programs as a result of the new legislation.
Under the reform, integrated networks between different health services will be put in place, organized by region. Alejandro Gaviria, an economist and Colombia’s current health minister, clarified that the country is to be split up into 10 or 12 regions, each with a minimum number of registered people. The aim is to better track patients’ health records to provide them with better, more personalized care.
The reform will also cut current services that do not result in direct diagnoses or cures.
Proponents of the legislation hope to see the law pass by the end of the year, while the full transition to the new plan could take two years. According to the House president Augusto Posada, “The two initiatives [healthcare reform law] will be passed before June 20.”
- Interview with Jorge Robledo
- Nuevo plan de salud incluirá lo que pacientes requieran (El Tiempo)
- Secretarías de Salud podrían asumir papel de EPS: Asmedas (El Colombiano)