RESUMO
BACKGROUND: Because of a change of government, the Colombian Ministry of Health and Social Protection is in the process of presenting a structural reform for the General System of Social Security in Health (GSSSH), in order to implement a 'preventive and predictive health model'. However, it will always be relevant to review and analyze the fiscal implications of any proposed public policy program, to protect financial sustainability and to promote the better functioning of the system in question. METHODS: To contribute to this topic, we have calculated, using a financial-actuarial approach, the loss ratio for the years 2017 to 2021 for the Capitation Payment Unit (CPU) for all the Health-Promoting Entities (HPE) for both contributory and subsidized schemes. This information, derived from public reports available on the official website of the National Health Superintendency, allows us to estimate the financial burden of the institutions that guarantee access to and provision of health services and technologies in Colombia. RESULTS: The study shows that close to half of the HPEs in Colombia (which represent 11.6 million affiliates) have CPU loss ratios of more than 100% for the year 2021, evidencing insufficient resources for the operation of health insurance. CONCLUSIONS: Finally, we propose some policy recommendations regarding the strengthening of informed decision-making to allow the healthy financial sustainability of the Colombian GSSSH.
RESUMO
En el presente artículo se aborda el análisis de la problemática del Sistema de Seguridad Social en Salud, centrándose en la problemática que se desprende de las relaciones del sistema con sus usuarios, aspecto éste que ha permanecido desatendido en los estudios y en los análisis sobre el tema. En particular se analizan los criterios y los aspectos determinantes que definen la elección de EPS (Entidades Promotoras de Salud) e IPS (Instituciones Prestadores de Servicios de Salud) por parte de los usuarios del régimen contributivo en la ciudad de Bogotá, prestando particular atención al ejercicio de la libre elección y la toma de decisiones informadas. El análisis de los resultados cualitativos y cuantitativos permite concluir que la información relevante disponible y el ejercicio de la libre elección son limitados.
This paper presents the analysis of the problems in Social Security and Health System due to the relations of the system with its users; problems that have been neglected in the studies and in the analyses on this subject. The determining criteria and aspects that define the election of Health Promotion Entities (EPS) and health providing institutions (IPS ) by the users of Bogota are analyzed whereby free election and an informed decision are pointed out. The analysis of the qualitative and quantitative results allows concluding that the available information and the exercise of the free election are limited.
No presente artigo analisa-se o Sistema de Seguridade Social em saúde concentrando-se na problemática que surge a partir das relações do sistema com os seus usuários, aspecto que tem sido negligenciado nos estudos e nas análises sobre o assunto. Em particular analisam-se os critérios e aspectos determinantes que definem a escolha da EPS (Entidades Promotoras de Saúde) e IPS (Instituições Prestadoras de Serviços de Saúde) pelos usuários do regime contributivo na cidade de Bogotá, com especial atenção ao exercício da liberdade de escolha e a tomada de decisão informada. A análise dos resultados qualitativos e quantitativos permite chegar à conclusão de que as informações relevantes disponíveis e o exercício da livre escolha são limitados.
