Congress has approved the most controversial points of the Health Reform in Colombia, which affect the future of the health insurance companies (EPS), the intermediaries between the government and hospitals and pharmaceuticals. The future of these private companies has been the subject of sharp parliamentary clashes in recent months, but finally the government has succeeded, and the articles referring to them have been approved by the Colombian legislature.
With the reform agreed upon in more than 90% of its content, the health insurance companies do not disappear but transform into Life and Health Managers, leaving their role as intermediaries between the State and clinics and hospitals. This decision marks a significant step in the legislative process of the reform proposed by the government.
Intense parliamentary debate
The finally approved articles have been the most complex of the toughest reform the government has undertaken. It is worth noting the severe crisis in April that led to the departure of several ministers and the break-up of the parliamentary coalition supporting the government in Congress. In May, the Conservative Party and the U Party became independent, departing from the government’s coalition.
In recent days, the two parties still in that coalition, along with the ruling Historic Pact, have also shown dissatisfaction and threatened to abandon consensus in Congress. Thus, the leader of the Liberal Party has announced that he will ask his party to leave the government and become independent, while the Green Alliance party has shown division on the matter.
Therefore, the final approval of these controversial aspects of the Health reform, which practically ensure the text’s ultimate success, is an important triumph for the government. Just a few days ago, it seemed unfeasible for the project to obtain the necessary political consensus. Similarly, this step signifies a significant failure for the conservative opposition, as their strategy did not work. Among the opposition parties’ political maneuvers, they first asked to change the agenda, then postpone the debate. When the votes did not favor them, they tried to break the quorum, but that didn’t work either.
They even challenged the Speaker of the House, Andres Calle, to prevent him from continuing to guide the debate. Calle was absent only yesterday, but his replacement, Vice President Fernando Niño, a conservative, also expedited the debate.
The future of health insurance companies, EPS
With the approved articles, a period of 2 years is established for health insurance companies to organize a transformation plan. After this time, what the reform terms Life and Health Managers (EGSV), new structures in the country’s healthcare management landscape, are expected to be fully operational.
This marks the end of the Health system as it has been known in Colombia for the last 30 years, where these private companies acted as a link between State payments and medical centers and hospitals providing medical services. When the text is fully approved, health insurance companies opting to become EGSVs must present a debt restructuring plan and adapt, within this period, to the new regulation that includes the prohibition of vertical integration. This is stipulated in Article 48 of the reform.
The nature of the EGSVs, which can be private, public, or mixed, must be accredited by the National Health Superintendence. Among their responsibilities will be coordinating with the new Primary Health Care Centers (CAPS), which will be created during this moratorium, and departmental and district health authorities, and comprehensive health risk management.
The norm aims to empower public management
In reality, all the political turmoil and bitter discussions around the reform revolved around the issue of mainly public or mainly private management of the system. For the former, the main argument is that already it is the State that covers almost all of the country’s medical expenses, through the private health insurance companies that end up covering hospital and pharmacy expenses.
During the three decades of service, dozens of these private companies have gone bankrupt, some with considerable scandals due to embezzlement and million-dollar misappropriation of public funds. However, defenders of maintaining the system argue that increased public management will only bring more corruption and worsen medical service to the population.
Although today the reform project has received a significant, almost definitive boost, not everything is done. There are only 9 articles left to discuss and approve, but they are equally controversial and divisive among political representatives. However, the government’s victory, and that of the Health Minister, who just this week was in the spotlight due to his speaking out about Covid-19 vaccines, has been one of the most important for the Petro government in the 15 months of its political journey.