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presupuesto en salud

The health budget in 2022!

Foto Francisco Garcia

Francisco Jose Garcia Lara
Surgeon and Master in Health Administration
from the Javeriana University
Columnist of the newspaper La Nación de Neiva

At the time of filing the 2022 budget bill in Congress, the finance minister affirmed that health represented the third sector with the largest budget within it (after education and defense), with an amount of $41.2 trillions.

For the preparation of this blog, the budget bill, the attached presidential message and the annexes of said project were reviewed [1], with the aim of specifying in the health sector which are the main items that are financed for 2022 .

 

Health spending

 

The revised documents state that health spending [2] includes the following:

 

  • Employer contributions for health of public employees of the entities that are part of the budget, affiliated to the contributory regime of the General Social Security System.
  • The affiliation of the poor population to the Subsidized Regime (subsidy on demand).
  • The provision of health services to the poor population not covered by the subsidized regime, through public hospitals (supply subsidies).
  • Attention to victims of catastrophic events and victims of traffic accidents.
  • The financing of public health plans and programs, aimed at the promotion and prevention of health and immunization plans for the population, especially the child population.
  • Health research, inspection and surveillance, and Hansen's sickness subsidies, among others.

 

The detail of health spending by groups and subgroups is shown below:

presupSalud-1

 

According to the documents reviewed, health spending represents 17% of the budget project and 3.9% of GDP.

 

In relation to the entities that carry out health spending, we have the following:

 

presupuesto para la salud

 

From the previous table, it is important to highlight that the Ministry of Health executes 82.7% of the sector's expenditure. Of the $38.228 billion in said ministry, $26.5 billion (69.3%) are for the financing of insurance, specifically the subsidized regime. Of these, 10.3 billion come from the general system of participations, that is to say, they belong to the territorial entities [4], although they are budgeted at the central level.

 

At this point it is pertinent to remember that the financing of the contributory regime comes from the contributions that are paid to the EPS, without these entities being able to confuse it with their own budget [5].

 

The budget of the entities of the health sector

 

In the annex of social spending are the eventual global budgets of the main entities of the health sector [6] for the year 2022, in which the amount for operation and investment is specified, also establishing the origin of the money (national contribution or own resources), as shown below:

 

presupuesto para la salud

 

presupSalud-4

Some insights on the health budget

 

The figures shown above present some inconsistencies that we consider pertinent to mention:

 

  1. The finance minister announced an amount of $41.2 billion for the health sector, but the expenditure determined in the revised documents is $46.220 billion. No explanation was found for the difference, although the first figure may correspond to the amount financed with the national budget, and the second, include own resources or other sources.
  2. Health spending includes employer health contributions that the national government must make for its employees, which are not strictly speaking a direct health expenditure, but are added to the financing of the contributory scheme.
  3. Additionally, the executing entities include the armed forces, teachers, care in prisons and other entities, that is, health spending includes all entities that make expenditures for the sector, not only the General Security System Social in Health established in Law 100 of 1993.
  4. In the presidential message, the value of the related spending for the health ministry is lower than that established in the social spending annex; additionally, the presidential message does not include the values determined as investment.
  5. On the contrary, in the National Institute of Health, the National Superintendency of Health and INVIMA, both investment and operation are included as expenses.

 

It is important to mention that the Administrator of Resources of the Social Security in Health (ADRES) is not in the national budget because in its creation [7] it was assimilated to an industrial and commercial company of the state, and by virtue of the order in Decree 111 of 1996, these types of companies are not included in the budget.

 

Regarding the budget of the sector entities, INVIMA and Supersalud are financed mainly with their own resources, while the ministry and the National Institute of Health depend for the operation and investment of national contributions.

 

It should be taken into account that the revised documents correspond to the initial project presented by the government to the congress of the republic, so it should be expected that adjustments will be made and probably the inconsistencies that have been commented on will be clarified or clarified.

 

Likewise, it is reiterated that the budget does not include the contributions received by the EPS from the contributory regime, which implies that the amount of $46.6 trillion pesos preliminarily determined in the budget as health expenditure, must be added the value of the employer contributions and contributions from dependent and independent workers that are not registered in the budget.

 

In any case, once the budget is approved in congress, a liquidation decree must be issued in which the items to be financed are established with greater precision, which are the values that will be assigned to each ministry and public entity.

 


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References

1. Bill No. 158 of 2021, House of Representatives

2. Pages 351 and 352 of the presidential message

3. It includes: Administration, management or support of activities such as formulation, administration, coordination and monitoring of policies, plans, programs and general budgets in the field of health; preparation and implementation of legislation and standards of action on the provision of health services, including the granting of licenses to medical establishments and medical and paramedical personnel; production and dissemination of general information, technical documentation and statistics on health.

4. They are resources that are budgeted in the territorial entities without a situation of funds, that is, they do not physically enter their accounts, but they do enter their budgets.

5. Judgment SU-480 of 1997 of the constitutional court.

6. Pages 13 to 15 of the social expenditure annex.

7. Article 66 of Law 1753 of 2015

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