Narratives and stories of current and future health systems

On the other hand, the claim by President Petro and his Minister of Health that resources are needed is not true: they believe that, compared to the EPS they receive, the UPC will increase by an average of 16% by 2022, i.e. more than Inflation last year was 12%.

In this article, we propose to analyze what the reality is between these two conflicting views of what the health sector is going through.

Of course, we clarify that some of the data we will present below were part of research done for EPS Sura by the three authors of this article, precisely to answer questions about resource adequacy.

We use the databases of the Department of Health and Social Care and all results obtained can be reproduced by requesting the Department to access these databases. Regarding the methodology, we will provide more details in the working paper of the Faculty of Economics of the University of Los Andes. The assumptions made in this document can be tested and discussed.

The strategy we use provides another perspective on multiple studies that have focused on prediction errors in technology costs and frequency of service usage. Along this line of thinking, our results showing insufficient resources allocated to EPS can be interpreted as a lower bound (i.e., reality may be worse than our data reveal).

Before discussing the methodology we applied and presenting the results obtained in our study, let’s review several factors that may explain why UPC may not have been sufficient despite a 16% increase: especially for some EPS .

The first factor has to do with what’s in the Health Benefits Plan (HBP) happening at the end of 2021. In fact, there are two types of costs in the health system: service and technology costs funded through: UPCs that receive EPS, and UPCs funded by other mechanisms.

For pharmaceuticals, active ingredients (substances in a drug that are associated with its therapeutic effect) funded through the UPC increased by 130% in 2022, from 459 to 1059 (data taken from the Health Update report) Funded by UPC resources in 2022 services and technology).

Through this inclusion, the UPC successfully funded 93.6% of the country’s Codes of Unique Medicines (CUMs). In terms of procedures, the total number of procedures in the PBS will reach 654 by 2022, reaching 9,197, accounting for 97% of the total number of procedures nationwide.

These inclusions mean that the cost is shifted from the top budget to the cost covered by the UPC received by the EPS.

The second factor has to do with the post-pandemic situation we are currently in. During 2020 and 2021, a large proportion of healthcare system users decided to postpone some surgeries that would normally be performed in 2022.

For example, according to the 2020 Johnson & Johnson medical device survey conducted by Ipsos, 77% of Colombians have delayed or canceled medical services.

However, some of these health procedures are related to diagnostic tests to detect certain diseases, but cannot be completed in time.

As in many countries around the world, delays in diagnostic testing have led to increased costs, as sadly to be expected, as some of the diseases patients currently suffer from are more advanced, more difficult and more numerous. the cost of treating them.

A third, more structural factor is that Colombia has entered a demographic transition: from 1993 to 2020, the number of people over the age of 59 per 100 economically active population nearly doubled, from 11.8 to 20.4 .

Colombia’s aging population means more and more users tend to spend more on medical services. For Colombia, the Development Bank of Latin America and the Caribbean (CAF) estimates that between 2015 and 2065, health spending will grow by 2.44 percentage points of GDP.

Due to the characteristics of the health insurance market in which EPS is involved, this aging phenomenon will bring about two consequences.

On the one hand, the formula determined by the UPC does not adequately accommodate this demographic shift, which explains EPS’ lack of resources to meet the medical costs of its affiliates. In particular, population aging exacerbates the increase in health spending brought on by the wave of new health technologies incorporated into the PBS by the end of 2021 (the first factor).

EPS, on the other hand, tries to stay with users who are expected to spend less than UPC, because although UPC is risk-adjusted and depends on the age of the user, it still has a lot of heterogeneity due to age range considerations, encouraging some EPS Choose risk.

EPS such as Colsanitas, Compensar, and Sura show relatively good performance metrics in treating sick users, and thus tend to attract more users who exhibit more severe epidemiological profiles, but they do not receive equitable Compensation (eg, sufficient UPC to account for increased risk to users).

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