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Colombia: far from a decent health system – Health

The mission of the national government is to promote and achieve full health care for all people, regardless of their race, religion, gender, political ideology, or economic and social condition.

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Access to health is a human right that preserves global security and claims the dignity of the entire populationwhile all human beings are, in one way or another, vulnerable.

The health system in Colombia, in theory, seeks to fulfill three essential purposes: to improve health, generate an appropriate care experience for citizens, and protect them against the negative economic effects derived from the disease.

In this sense, the health system must be strengthened as a guarantee of a fundamental right and of an essential public service. Strengthening implies considering a praxis that is up to the social, economic, political and cultural challenges. The problems and challenges for Colombia are enormous and are summarized below.

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Currently, the system presents a reduction in the supply of primary level health services and a sustained decrease in quality
. The best development of primary services is found in large cities and in the contributory regime, which leaves out access to quality for a good sector of the population linked to the precarious subsidized system; Traditionally, the implementation of public policies by the national government has not reached regional governments, leaving peripheral territories and people with low incomes marginalized and left behind.

In the last two years, of the 14 existing EPS in the contributory regime, nine were stable and met solvency requirements; As of today, three of them have already been liquidated (Cruz Blanca, Coomeva, Medimás) and there are two others still at risk (SOS, Comfenalco Valle). Of the 30 EPS of the subsidized regime, nine have been closed in the last two years and only six are still viable (Mutual Ser, Co salud, Nueva EPS, Cajacopi, Anaswayu, CCF Chocó). The rest, 15 EPS, are financially unviable, 11 of them with a special surveillance measure from the National Health Superintendence, two of them with a recovery plan (FND, 2022).

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The data proves that The Colombian health system has had more failures than successes. It is the health entrepreneurs who are really benefiting from the model and not the people who demand it.

Although the current government seems to be proposing alternatives, to date the sectoral and intersectoral government mechanisms and instances are inactive and there are clear deficiencies in the coordination and integration of actions. An example of this is the low articulated participation of actors in the formulation of planning processes necessary for the good governance of policies.

The centralist State model has been losing legitimacy, the institutions are becoming weaker and more passive when it comes to acting. The regions claim to be heard and taken into account when deciding on how to solve health emergencies, which are expressed not only in the meager attention to physical and mental illness but also in the lack of prevention strategies.

Our weak public health is a reflection of the shameful sociological, cultural and political ignorance that the State has had about the disease as a social construction.

There are several obstacles that prevent citizens from exercising their full right to health. There are many people in Colombia who are not affiliated to the system because they do not have the economic capacity to contribute, the paradox is that they are not entitled to a subsidy either. It seems that the only Colombians who can claim their rights are those who live in the center of the country or have medium and high economic capacities.

In turn, the precarious subsidized system gives the impression of offering broad coverage; a significant population has a membership card, but attention is limited to filling the waiting rooms without giving effective access to consultations, examinations and treatments.

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Thousands of Colombians cannot access services because the municipalities where they reside do not even have a primary health offer, due to the poverty in which they live. Others are denied service, because their EPS have canceled the contracts, usually due to non-payment. It is not fair that those who pay the piper of bad administrations are the users, the people, the people.

Our weak public health is a reflection of the shameful sociological, cultural and political ignorance that the State has had about the disease as a social construction.

There is a perception of lack of transparency in the sector that is not free. Cases of corruption and mismanagement have deteriorated the legitimacy and trust in the system, causing a low reputation and social discontent that continues to grow with the passing of the days. In addition, among the agents of the system themselves: EPS, IPS, medical professionals, suppliers of all kinds, commercial and contractual relationships are marked by a perception of distrust, caused by actions of dishonesty noticed in business relationships (FND, 2022 ).

In sumthis is the result of a model based on accumulation and profit and not on the fulfillment of rights.

The majority of public hospitals in Colombia are economically unviable; they exist under a persistent operating deficit and at high financial risk. The fact that these have as their main source of financing the EPS of the subsidized health system, and that most of these are in a bankruptcy situation, means that hospitals not only have notorious difficulties, but also cannot reach commercial agreements. in which they are not in a disadvantaged relationship.

It is worth remembering that there are EPSs that are under the magnifying glass of the Comptroller General’s Office for dealing with interests that are very different from those of the health care of their affiliates.

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Public hospitals also depend, to a large extent, on territorial entities, governorships, and mayors’ offices, which do not have sufficient treasury to cover the cost of quality health services.

It is not wrong to say that the centralization of the nation’s resources in terms of health generates inequalities and injustices throughout our country, since in Bogotá the real needs of the territories are unknown, which, it is also worth clarifying, are covered by the jurisdiction of the state.

The national government passes over the Constitution and nobody seems to raise their voices, powers continue to be assigned to territorial entities without previously assigned resources. At the same time, it is the territorial entities, despite their limited budget, who have not allowed the health system to collapse in Colombia.

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To reduce the problems of the health system, a series of actions are proposed: guarantee the resources so that public hospitals can receive the necessary financing for a decent service provision. The departmental and municipal health secretariats do not have sufficient resources to meet the needs of the population, in this sense fiscal decentralization is urgently needed in favor of our regions.

Finally, the health insurance model must be reformed to unify the subsidized and contributory regimes in order to have a more equitable country with quality services; equitable in the sense that we all enjoy the same benefits, regardless of ability to pay; of quality in the sense that all of us, in our own right, have access to quality and high-tech treatments, procedures and medicines. He who is healthy has hope and he who has hope has everything in life.

In last, Is the system more focused on business than health?

PABLO JARAMILLO ARANGO
PhD Candidate in Political and Legal Studies

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