Colombian Government and Health Care Companies Reach Agreement

An agreement between the Colombian government and healthcare service providers was announced following a last-minute meeting held on the evening of Friday, November 3. The meeting included representatives from the Ministry of Health and the Colombian Association of Integral Health Enterprises (ACEMI), which acts as the employers’ organization for the private healthcare sector.

The Minister of Health and the president of ACEMI aimed to reassure members of the Health Insurance Companies (EPS) about medical care and the regular supply of medicines. Nervousness arose a few days ago when one of the country’s major health insurance company providers, Sanitas, received a notification from its pharmaceutical supplier announcing the suspension of medication supplies to its members. The reason behind this was a significant debt of 400 billion pesos incurred by Sanitas with Cruz Verde, the pharmacy chain with which the healthcare provider has an agreement.

Agreement until the end of the year

The agreement reached after the meeting includes the timely payment of maximum budgets for November and December and the 2022 adjustments, totaling 820 billion pesos.

“The government committed to obtaining resources for the sector, and we will continue discussions to agree on the adjustment figures for 2022, as we have different figures,” Vesga stated on Friday night.

Another aspect of the agreement is the initiation of the government’s process of making direct payments, which is one of the main aspects of the ongoing healthcare reform under discussion in Congress. In this regard, the president of ACEMI announced that the Ministry of Health would pay healthcare service and medication providers directly, without these funds having to pass through the health insurance company, as is the case now.

This means that pharmaceutical expenses, which are already covered by the government, would be paid directly to the drugstores, without having to be first processed by private insurers.

Negotiations will continue

Both parties scheduled another meeting for Tuesday, November 7, with the intention of continuing negotiations to find longer-term solutions. “There is, of course, concern about the issue of financing, but, as I said, the government is committed to seeking resources for the year-end and continuing discussions about sufficiency for 2024,” said the president of ACEMI.

One of the objectives is to increase the agreed-upon amount from this last meeting, as it is believed that the total of 820 billion pesos does not cover the entire amount needed. “The commitment is that on Tuesday, we will talk again to start that agenda of working sessions. The discussion of the reform continues in Congress; this is a space between the stakeholders and the government, where we want to continue working on the articles. There are doubts, and the idea is to overcome them,” Vesga stated in an interview with El Tiempo newspaper.

The Situation of Sanitas

Regarding Sanitas, government sources claim that payments are up to date, both to the insurer Sanitas and its medicine supplier, Cruz Verde. This recent crisis in Colombia’s complex healthcare system was precisely due to the large debt that Sanitas has with Cruz Verde, and the government insists that this is not the only debt the insurer has with its suppliers.

“They have significant debts from what we have seen by reviewing what the Colombian Association of Hospitals and Clinics has presented, what this supplier, Cruz Verde, has presented, and what many others have. What they cannot say is that the government owes them money because this year they have been paid 7.8 trillion pesos promptly, monthly, and the maximum budgets are up to date as of October,” stated the representative of the government entity responsible for payments to private healthcare companies.