As the government’s conflict with Health Promotion Entities (“EPSs”) intensifies, considerable turmoil is expected over the next 6 to 12 months. Due to multifactorial causes, financial pressures on EPSs are likely to deepen, potentially leading to bankruptcies and disruptions in service delivery.  

The roots of this crisis are complex and longstanding, exacerbated by increased post-pandemic demand for “health services, administrative mismanagement, corruption, the expansion of the Health Benefits Plan and delays in government payment,” listed a legislative advisor with more than 15 years of experience. The defunding of the system and insufficient resources from the Capitation Payment Unit (“UPC”) have further aggravated the crisis, putting most of the country’s EPSs under intervention measures. 

In April, the Comptroller’s Office reported a financial detriment of over 9 billion pesos in 18 audited EPSs, “which generated a lot of controversy due to discrepancies in reporting systems,” continued the legislative advisor. This financial distress is further highlighted by the Superintendence of Health’s revelation of a 5 trillion pesos deficit from the 2023 fiscal year.

Mismanagement, hidden invoices and administrative cost overruns have contributed to the liabilities of EPSs such as Sanitas, Compensar and SOS. “This multidimensional crisis has generated a significant deterioration in the provision of services, seriously affecting users and putting the lives of thousands of people at risk,” warned a former senior manager in public health. 

The proposed health system reforms could worsen matters by imposing new regulatory burdens and altering funding structures, leading to further instability. “We do not know what will happen in the legislative process.” The legislative advisor in the Congress of the Republic continued, “What we see today is that experience has shown that most of the EPSs that are intervened end up in liquidation.”  

“What we see today is that experience has shown that most of the EPSs that are intervened end up in liquidation.”

Legislative advisor in the Congress of the Republic, Colombia

The transition process and financing remain contentious issues, raising concerns about the potential for disorganisation and service discontinuity. Ensuring a consensual, relevant and orderly reform, “it is crucial that a broad and informed agreement among all actors in the health system is established,” highlighted the former senior manager.

The government’s ability to navigate these reforms and stabilise the EPSs will be crucial in determining the extent of the crisis and its impact on the broader health system. “This is obviously a Herculean task, and the government is not ready. I think they already realise that,” continued the manager. 

“Sura EPS will continue to provide all health services until the voluntary withdrawal is effective,” informed the former public health sector employee. As Sura pulls out and other EPSs face similar challenges, the fate of over 5 million Sura affiliates becomes a critical concern.

“The reality is that the state health system is already under a lot of financial and operational pressure and adding so many users to other already weakened EPSs could worsen the situation.” The manager expanded, “This could cause possible collapses in services and longer waiting times for the provision of health services.” The transition process, involving a 65-working-day review period followed by a three-month gradual dismantling, could be chaotic, causing further patient disruptions.  

“The reality is that the state health system is already under a lot of financial and operational pressure and adding so many users...could worsen the situation.”

Former senior manager in the public health sector, Colombia

The future of EPSs and the health sector in Colombia appears uncertain. “The health reform, which was one of President Petro's flagships, has fallen in Congress.” The legislative advisor added, “With the collapse of the reform, the government announced that it will seek to make changes to the system via decrees.” However, the reform proposed by the national government could further aggravate the already delicate situation, especially in a fragmented legislative context. “Political tensions between the different political parties make it difficult to implement necessary structural changes,” stressed the senior manager. 

“The real solution requires a profound structural reform that goes beyond the mere existence of the EPSs. The focus should be on resolving the financial deficit and ensuring long-term sustainability.” A current advisor to the private health sector continued, “Technical consensus on revising the Capitation Payment Unit, establishing effective cost containment mechanisms and promoting public-private collaboration is essential.”

An inclusive dialogue involving all health system actors and political parties, based on detailed technical analysis and evidence, is crucial for an effective and sustainable reform. The government’s ability to navigate these complex challenges and build a sustainable framework will determine the future of Colombia’s healthcare system and the care of its citizens.