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gasto no PBS

What is the non-PBS spent on?

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

Spending on services and technologies not included in the Health Benefits Plan (formerly the Obligatory Health Plan or POS) has been one of the most controversial issues in the health system, lending itself to countless speculations.

In this blog we will review that expense based on the data corresponding to what was approved in 2019, which were requested from the Administrator of Resources of the General Social Security System in health (ADRES).

What is No PBS?

Initially, it is important to mention that in Colombia there is a health benefits plan (PBS), which is defined in the second article of Resolution No. 5857 of 2018, as the set of health services and technologies charged to the Unit of capitation payment (UPC). The PBS includes health promotion, prevention, diagnosis, treatment, rehabilitation and palliation of the disease, constituting a mechanism for the protection of the fundamental right to health.

 

Consequently, it should be understood that the so-called No PBS corresponds to those health services and technologies that are not included in the aforementioned plan, and therefore, are not financed by the UPC.

 

Until February 2020, the EPS authorized non-PBS services or technologies and recovered it from ADRES. Currently, the EPS authorize and pay directly for the service or technology in accordance with the so-called ceilings or maximum budgets. [1]

 

What was approved and how much did it cost?

The information received from the ADRES reports that for the year 2019 a little less than $1.350 billion were approved in Non-PBS technologies and services, which although they do not represent the total value of these services or technologies provided and charged, they are a sample valid to do an analysis.

 

The data were classified into the categories established by ADRES and the expenditure in each of them is shown in the following table:

 

Gasto no PBS 1

 

To complement the information, the approved expenditure of the first five (5) items in each of the categories was also requested, which we summarize as follows:

 

Gasto no PBS 2

 

Among the first five items, it is striking that there is a drug for diabetes, another for prostate cancer, and three monoclonal antibodies. Added to the spending in the first five, these represent about 10% of the total approved in medicines.

 

Gasto no PBS 3

 

Regarding the procedures, two are for immunotherapy, two correspond to bariatric surgeries (to lose weight) and one to a cardiology procedure.

 

Gasto no PBS 4

Regarding complementary activities or services, these are not properly considered as the provision of a health service.

 

The first item corresponds to diapers, while the next four are different types of patient transport.

 

Gasto no PBS 5

 

Nutritional supplements include high-protein supplements such as Prowhey Net, Ensure Clinical, and Nepro BP. Also, foods with special medical purposes such as Glucerna for diabetics and Ensure Advanced

 

Gasto no PBS 6

 

In this category, the top five are diapers.

 

It is important to specify that this classification of diapers corresponds to the one that existed before Mipres, so this expense could eventually be added to the value that appears in complementary services.

 Gasto no PBS 7

 

Regarding the devices, the first corresponds to cochlear implants and the other four to different types of wheelchairs.

 

By way of reflection

The figures shown above correspond to the values approved in 2019, without having reviewed the formulation or ordering frequencies of the main Non-PBS services and technologies [2], since these figures were not the subject of this blog.

 

Because the information provided by ADRES refers only to what was approved, it was not considered appropriate to calculate the percentage of spending on Non-PBS over the total spent in the year in the health system.

 

Regardless of the foregoing, and in order not to fall into our own interpretations, we consider that the information on Non-PBS spending forces us to question the following:

 

  1. Which of the Non-PBS technologies or services produce a cure or a better quality of life for patients?
  2. Is it absolutely necessary for the health system to assume everything that is not included in the PBS, or could some be discarded, and perhaps require co-payments according to socioeconomic strata?
  3. Are Non-PBS technologies and services being abused?
  4. Is there any other health system in the world that authorizes the type of services or technologies that in Colombia we call No PBS?
  5. To which socioeconomic strata do the patients who receive the Non-PBS services or technologies mainly belong?

 

These questions are undoubtedly controversial and represent the most critical issues in the health system, on which there is still much to study and review.

 

However, there is no known health system in the world that has a complement to such a broad benefit plan, financed with public resources, such as the Colombian one. In some countries, several of the drugs or supplies included in Colombia are financed, but not to the extent that we have in our country.

 

There are also systems that offer insurance or supplements that allow the coverage of the benefit plan to be expanded, but these are financed with private resources and are voluntary, not mandatory.

 

Taking into account that the highest expenditure corresponds to medicines (89.2%), it is important to reiterate that as of March 2020, in accordance with the so-called ceilings or maximum budgets (Article 240 of Law 1955 of 2019, Resolutions 205 and 206 of 2020 of Minsalud), the EPS must assume the risk and payment of the so-called No PBS.

 

Next year it will be very interesting to compare the spending of 2019 with 2020, to verify if these entities were truly efficient in controlling spending with this new scheme, or if at least they were able to rationalize it.


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References

1. For greater precision consult the blog that is in: https://www.neuroeconomix.com/los-techos-en-el-sistema-de-salud/

2. The frequencies of No PBS in 2018 can be consulted at: https://www.adres.gov.co/Portals/0/Noticias/Publicaciones/Informe_MIPRES_2018

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