The agreements reached by the government parties with the Minister of Health and the President of the Republic would not be enough to guarantee health care for Colombians.
At least that is the view of the former minister of that portfolio in the previous four-year period, Fernando Ruiz, who -due to the debate on health reform- made his debut on virtual stages with his Tik Tok channel, where he has dedicated himself to do pedagogy about the health system. Although he is a former official of a government antagonistic to the current one, a thirty-year career in the sector gives his voice authority to speak of perhaps the most sensitive reform for the entire population.
In this sense, in his most recent video he spoke about the proposal of the Liberal, Conservative and La U parties, whose directors agreed on 20 points on the project with the Government to move it forward, although with the haste and some doubts of former President César Gaviria. .
In addition, in dialogue with EL COLOMBIANO, Ruiz warned of two alerts about the modifications that these parties made to the original text, which, he said, must be resolved in Congress.
The role of system health insurance
Although the former official acknowledged that, after the agreement, “there are some important improvements” such as freedom of choice, the inclusion of the concept of social security and clarity on primary services and primary health care, “the critical core is in the role of the insurer, who must be able to manage risk and provide effective financing”.
In this sense, he explained that the current model has three resource funds that are managed by health care providers (EPS): a resource fund for health spending, another for reserves, and one for administrative expenses.
These funds work in a chain: that is, if the money for spending on health is not enough, the insurer requests authorization from the national government to be able to use the reserves and, if the money is still not enough, the stock of funds is available. administration expenses. “They must do it because the EPS are jointly and comprehensively responsible for the care of Colombians with a contract,” Ruiz said in his video on Tik Tok. If after having these resources it is not enough, the insurer has to respond with its own assets.
This map in the parties’ proposal, according to Ruiz, changes, although not as much as in Carolina Corcho’s project. In the one proposed by La U, liberals and conservatives, it changes in that a resource administrator tells the EPS (or EGVIS, a health and life management company) “I give you 5% for managing and you only respond to where the money reaches (from the health spending fund)”.
Given this, the former Minister of Health predicts that the government may not have enough money, “the administrator washes his hands and Colombians wait for them to give us health services or pay for private insurance to meet our needs.”
In line with this, Ruiz told this newspaper that the role of the insurer is the main thing to resolve so that “it doesn’t end up turning into a Frankenstein if the government doesn’t give in.” He also added that the reform with the 20 points that the parties included “is less problematic than the original, but it does not solve the problem of what to do when the budget to care for the gene runs out and how to modulate a model in which insurers have the possibility of generating your network and making contracts and payment issues”.
Effectiveness of the preventive model in health
The change of focus in the health system, which is based on curing and treating the disease and not on preventing it, is a banner of government reform and has been one of the red lines that President Petro and Minister Corcho have supported in the five weeks of debates and public hearings after it was filed in Congress.
Faced with this, in the dialogues and negotiations with Dilián Francisca Toro (of La U), Efraín Cepeda (of the Conservative) and César Gaviria (of the Liberal) this has not been a point of contention, since it is one of those they have in common not only in these communities but also among health systems scholars.
To carry it out, among other actions, the Government has proposed brigades and medical teams in remote areas of the country (“deep Colombia”, as Corcho says) to go to people’s homes to assess their state of physical and in order to detect possible ailments in time that can be treated in a timely manner before they progress.
However, Ruiz maintains data that calls into question that prevention is synonymous with curing a disease. Several are present in a study by Canadian experts Marc Lalonde, former Minister of Health, and Alan Dever, epidemiologist, who point out that health services contribute 11% to someone’s state of health. Other aspects such as the environment (19%) and lifestyle (43%) are more decisive.
Meanwhile, given the possible white smoke of the political negotiation, Congress will have to weigh between the proposals that are making a career and what are the alternatives to address the points that generate fear, among which are these contributions from former Minister Ruiz.