How much has been recognized as public debt in the end-point agreement?
Francisco Jose Garcia Lara
Surgeon and Master in Health Administration
from the Javeriana University
Columnist of the newspaper La Nación de Neiva
For several years, a large debt of the Administrator of Resources of the Social Security System in Health (ADRES, formerly the solidarity and guarantee fund - FOSYGA) accumulated with the EPS that operate in the contributory regime, for the inputs, procedures and activities not included in the Health Benefits Plan (PBS, previously Obligatory Health Plan - POS).
To resolve this considerable liability, in the development plan (Law 1755 of 2019), it was established that these commitments are paid through public debt. For such purposes, the national government issued Decree No. 521 of 2020, through which the procedure for auditing and recognition as public debt of the invoices submitted by EPS to ADRES for this concept was defined.
Subsequently, through the first article of Legislative Decree No. 800 of 2020, a paragraph was added to article 237 of the aforementioned law, authorizing the 25% advance payment of the value of the recoveries presented by EPS to ADRES.
The strategy described above has been commonly known in the health sector as an end-point agreement .
To verify compliance with the agreement and the aforementioned regulations during 2020, the Ministry of Finance was requested through a right to petition , information on the securities approved as public debt for these payments.
The main aspects of the information provided in the right to petition are listed below:
As a previous step to the audit and recognition process in the ADRES, and in the Ministry of Finance itself, the Superior Council of Fiscal Policy (CONFIS) authorized the sum of $2.303.665.665.749, as part of the definitive adjustment of health obligations with Debt service charge established in article 237 of Law 1955 of 2019.
In this vein, the aforementioned amount was the cap in 2020 to assume the payment of health services and technologies not included in the PBS as public debt,
that will be approved in accordance with the audit process carried out by ADRES.
Consequently and in accordance with the procedure established in Decree 521, the authorization granted by CONFIS allowed the national government, through the Ministry of Finance, to recognize as public debt up to that amount, and ADRES to request the Ministry of Finance the transfer of said monies to make payments to the EPS.
The amount approved as public debt
Article 21 of decree 521 establishes that after auditing the accounts, the ADRES certifies to the Ministry of Finance the amount recognized by each EPS, and this in turn, as ordered in article 22 of the same decree, issues a resolution recognizing it as a debt public the value reported by the ADRES.
In compliance with the above, the Ministry of Finance issued 15 resolutions between October 8 and December 30, 2020, recognizing as public debt an amount of $342,374,825,038.63.
Of this amount, the sum of $193,599,436,047.32 (56.6% of what was recognized) are advances of 25%, as ordered in Decree 800 cited at the beginning of this blog. The remaining value, $148,775,388,991.31 (43.4% of what was recognized) corresponds to values approved by the ADRES audit.
Approved by EPS
The distribution of the aforementioned amount for each of the EPS is shown in the following table:
Coomeva was the EPS to which the most money was approved, followed by Sura, Nueva EPS, Salud Total, Cafesalud in liquidation and Sanitas, representing among these six 86% of the approved amount.
Is the endpoint agreement being honored?
In the first place, we must remember that the Presidency of the Republic affirmed that the amount available for the payment of the end-point agreement in the contributory regime was $5.2 trillion .
In this vein, the amount authorized by CONFIS for 2020 ($2.3 trillion) corresponds to 44.2% of the announced value ($5.2 trillion). In turn, the amount approved to the EPS is 6.6% of the available value, and 14.9% of that authorized by said council.
In this way, what is approved as public debt in the end-point agreement, and, therefore, recognized to the EPS, is a significantly lower value compared to what is available, authorized and eventually owed, the latter according to some analysts on the subject exceeds the $7 billion.
It is important to mention that the debt for the No PBS is several years, consequently, it is not easy for it to be resolved through an audit in the ADRES in such a short period of time (six months from the approval by CONFIS).
In any case, 21 EPS benefited according to the table presented, which implies that all of them signed the transaction contract established in article 16 of Decree 521 of 2020, that is, it is possible to affirm that all EPS operating in the regime finally accepted the procedure established in the same decree.
It is evident that six EPS benefited mainly in the approval of the amounts owed by the No PBS as public debt, being significant that the 56.6% of that approval was made as an advance for the recovery values presented, that is, the audit of ADRES was in arrears as of December 31, 2020.
For the year 2021, according to the response to the right to petition at the beginning of this blog, the CONFIS was requested to authorize the national government to assume as public debt the amounts pending payment to the EPS for the so-called No PBS (amount not executed in the year 2020), therefore, the total execution of the $5.2 trillion of which is available has not been programmed as stated by the national government.
In short, there is an incipient compliance with the end-point agreement and there seems to be no intention to comply with the amount announced by the national government, we reiterate $5.2 billion, in the year 2021.
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1. For more information on this topic, it is recommended to consult the following blogs: https://www.neuroeconomix.com/de-que-se-trata-el-acuerdo-de-punto-final/ https://www.neuroeconomix.com/los-avances-del-acuerdo-de-punto-final/
2. Right to petition answered by registered entry No. 1-2020-057586, dated January 29, 2021, signed by Lina María Londoño González, coordinator of the legal affairs group, general direction of public credit and the national treasury of the Ministry of tax authorities.