:quality(85)//cloudfront-us-east-1.images.arcpublishing.com/infobae/G6EIDGDGYVFUHKB7R4VB7CK464.jpeg "\"They plan to create more bureaucracy, less health and without new sources\", the director of Gestarsalud spoke of the differences that the group has with the health reform 1")
There health reform proposed by the Government national raised various comments, some positive and some negative. The unions that demonstrated against mentioned that what was proposed by the Ministry of Health and approved by the President, Gustavo Petrothis could bring several problems, in addition, that they believe that despite the fact that the minister Caroline Liegesaid I was trying to put all the suggestions together in the document, in the 100+ pages it doesn’t feel put together.
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He talked about it Carmen Eugenia Dávila, director of Gestarsalud, the EPS trade union association of the subsidized scheme, which found multiple risks in the reform proposed by the national government, among which, a lack of articulation between the primary care centers (CAP) and the second and third care centers levels and bureaucratization of systems.
Although it should be noted that the union leader also recognized two positive aspects of the bill: the intention to characterize the population of the most remote areas of the country and to create a master plan of equipment for public hospitals.
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GlobeLiveMedia: From the beginning, as a professional association, did you consider a reform necessary and relevant?
Carmen Eugenia Davila (CD): We believe that it was important to improve certain aspects of the system and in this sense, we agreed with a reform that is based on what had already been built. But, what we see in the proposal is the opposite: it destroys what has been built and I believe that it is not good for anyone, neither for the millions of people and Colombians, nor for human talent in terms of health, nor for the public officials who have helped and who have contributed to the construction of this system. But, fundamentally, this does not suit the populations and the beneficiaries of the health system.
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GlobeLiveMedia: Why do you think the reform does not suit people?
CD: We see that health is nationalized. A monopoly has been proposed through the Decentralized Administration, which will manage all the resources that today belong to the insurance and manage them in a national health system based on budgets. This eliminates the possibility of free choice of users with all the risks involved in an exclusive State administration without any type of competition.
Nowadays, a person has an EPS and if he is not satisfied with what he is doing, he has the possibility of complaining. In this scheme that they propose to us, we are in the hands of state entities and not just one entity, but several public funds, various institutions that are being created and finally the responsibilities are dispersed, so that the users will not be clear who answers for everything.
GlobeLiveMedia: Will the EPS stop?
CD: Undoubtedly, the EPS is coming to an end and with it important functions such as risk management, health risk management and other important insurance functions are being removed.
In the reform, a lot of institutionality is created, with the resulting bureaucracy and with the risk of costs that the Colombian State cannot pay or maintain what is most important for the user.
GlobeLiveMedia: How will the user concerned see himself with all this?
CD: The user is affected because we see an imminent risk of fragmentation of treatments, since the number of Primary Health Care Centers (CAP) has been created, which will be the gateway to health, but they will, from one hand, and they do not belong to the same governance of medium and high complexity levels.
So I’ll give you an example: in the proposed system, you walk into a primary care center, a general medical consultation, they see something complicated and they send you to a specialist neurologist for an MRI. This MRI and this neurologist specialist are of a second level of complexity, so they refer you there without any real integration of health services. These are two different managers and this second and third level of complexity will belong to the entities called Deconcentrated Addresses, which are the regional ones. Obviously, there is an infinite risk of fragmentation of treatments.
Finally, no one will be responsible for what happens to the user because there are multiple parties involved in the transit of users. Due to today’s health care system, we have networks in which EPS have worked. There are several issues with timing, availability, etc., but there are a few networks.
In the new system, these networks disintegrate, disappear and we have to start from scratch with the resulting risk to the people who are today patients and frequent users of the health system, many of whom suffer from high cost diseases. , who will be taken seriously concerned by the continuity of their treatments. Responsibility is undoubtedly dispersed, so ultimately when this happens no one answers.
GlobeLiveMedia: So, in this scenario, what would happen to the healthcare system?
CD: The finances, which are important to guarantee the right, will collapse because there is no management of the financial risk, nor planned.
Today, the financial risk is managed by a premium or capital payment unit available to the EPS and which must reach them in order to be able to provide all the health services. In the proposed scheme, the entities provide services with historical forecast budgets. So when the budget runs out, what happened 30 years ago will happen: that’s it.
When people are used to receiving treatments and receiving checks, that obviously goes against the users. We see that they plan to create more bureaucracy, less health and all this without new sources.
So what is going to happen is that there will be more and more financial strains and all of that works against the user. They propose a national health model where most of the provision, administration and contracting will be done by public entities.
GlobeLiveMedia: Do you see anything positive in health reform?
CD: Yes, we have highlighted the positives which are retained here. On the one hand, these EMIT groups, which are groups that will be in the regions trying to characterize the population and traveling through the scattered areas of the country. We consider this important, as long as they are articulated with the institutionality that we have today and with the EPS, through the best technological systems so that the treatment can continue if any type of risk is identified.
It should also be noted that it is a question of the Master Plan for the Equipment of public hospitals, which relates to infrastructures and the adaptation of equipment. Today there are no master plans, Bogotá has made one, and I think supply planning should be a state responsibility. It always has been, but it has not been exercised. This initiative seems most useful to us.