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Financially: How did the EPS of the subsidized regime fare in 2020?

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

In the previous blog we show the most significant financial results of the EPS of the contributory regime in 2020. This presents the observations on the financial behavior of the EPS of the subsidized regime, based on the information in the financial statements as of December 31 2020, which can be found on the website of the National Health Superintendency (1).

 

Income and affiliates

Once again, we insist that the income (2) of the EPS depends mainly on the affiliates, taking into account that each one of them receives the Capitation Payment Unit (UPC).

According to the information found on the website of the Administrator of Resources of the General System of Social Security in Health (ADRES) (3), the affiliates to the subsidized scheme as of December 31, 2020 were 24,032,196; a figure higher than 22,836,732 as of the same date in 2019 (1,195,464 difference).

 

Because the New EPS, Medimás, Mutual Ser and Coosalud, are registered in the revised information as EPS of the contributory and subsidized regimes, and that their financial figures were presented in the previous blog on the EPS of the contributory regime, it is not possible to are analyzed in this writing.

 

The following table shows the 10 EPS of the subsidized regime with the highest income and the affiliates they had as of December 31, 2020:

eps subsidiado1

 

In general, it can be stated that the greater the number of affiliates, the higher the income, although some EPS show lower or higher income compared to others with a lower number of affiliates, which can be explained because the income presented corresponds to the entire year of analysis, while that the affiliates only correspond to the cutoff of December 31. It may happen that the number of affiliates has increased or decreased during the year, which affects income throughout the period as explained above.

 

The total income of the EPS that are registered as authorized to operate only in the subsidized regime was $14,841,288,745,781 and the number of affiliates was 12,973,778.

 

Accounts receivable from territorial entities (4)

Prior to the issuance of Law 1955 of 2019 (development plan), care for interventions or activities not included in the Health Benefits Plan (No PBS) were assumed by the EPS and recovered from the governorates or districts. Currently, the aforementioned activities are included in the ceilings or maximum budgets (5).

 

The 10 largest debts of the territorial entities for this concept with the EPS of the subsidized regime, compared with the total accounts receivable of the aforementioned entities, are the following:

eps subsidiado2

 

In total, the debts of the territorial entities reported by the EPS amount to $374,040,791,515, which represent 30.9% of the accounts receivable from these entities.

 

The results (7)

Regarding the results, the following table shows the comparison between the years 2019 and 2020 of the 10 EPS that presented the best results in 2020.

eps subsidiado3

 

In accordance with the information revised in 2020, when adding all the EPS of the subsidized regime, these obtained as profit or surplus the sum of $171,411,622,949, which means a good result compared to what was found in 2019, year in which which the loss was $677,176,655,889.

 

Regarding the EPS that had losses in 2019 and 2020, the following was found:

 

eps subsidiado 4

 

Minimum capital and adequate equity

Contrary to what was presented for the EPS of the contributory regime, in the report of the National Superintendency of Health on the evaluation of compliance with the conditions of minimum capital and adequate equity of the EPS (8), only two EPS of the subsidized regime comply with both conditions: Cajacopi Atlántico and Comfachoco. The other EPS do not meet either of the two conditions.

 

In 2020, the EPS of the subsidized regime Cajacopi Atlántico, Comfasucre, Savia Salud and Comfamiliar Huila, requested authorization from the Supersalud for an Institutional Reorganization Plan and / or Financial Adjustment Plan, without the date of the aforementioned report having been issued such authorization. For its part, Convida requested authorization for capitalization, which had not been issued as of the date of said report. Finally, the liquidation of Comfacundi and Comfamiliar Cartagena was ordered.

 

How did the EPS fare?

As was found for the contributory regime, there was an increase in those affiliated to the subsidized regime, possibly due to people who were left without work and had to move from the regime. In any case, the total number of affiliated to the health system increased by 1,720,906 (1,195,464 in the subsidized and 525,442 in the contributory).

 

We must reiterate that EPS income depends on the number of affiliates and that these do not belong to the EPS but to the health system, therefore, they cannot be confused with their own assets (9). Consequently, income is not the best indicator to consider when analyzing the financial situation of EPS.

 

There remains a substantial debt of the governorates and districts with the EPS of the subsidized regime, this figure being approximately one third of what they owe to these entities.

 

Regarding the results, there is a substantial improvement in relation to 2019, when adding all the EPS it was found that they gave positive results in 2020, while in 2019 there was a loss. The profit is slightly higher than the 1% of the total income of the EPS of the subsidized regime.

 

In contrast, only two EPS meet the conditions of minimum capital and adequate equity, that is, despite the improvement in 2020 results, these are not enough to resolve the losses of previous years.

 

Additionally, it should be remembered that since 2020 the maximum ceilings or budget were established for the payment of activities or interventions not included in the Health Benefits Plan, which implied an improvement in liquidity, however, it cannot be affirmed that is the reason that explains the results obtained.

 

Finally, it is essential to bear in mind that the difference between the UPC of the contributory regime and the subsidized regime persists, which in accordance with the provisions of Resolution 2503 of 2020, issued by the Ministry of Health, is $938.826 in the contributory, compared to $872.496 of the subsidized regime ($66.330 difference per member). This implies that by having equal PBS in the two regimes, a lower value is being recognized in the subsidized, which in the long run could be the cause of the accumulated deficit in this regime.

 


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References

1. https://www.supersalud.gov.co/es-co/Paginas/DelegadaSupervisionRiesgos/informacion-financiera-EPS-EMP-SAP-regimenes-de-excepcion-y-especiales.aspx

2. Code 4 of the revised information

3. https://www.adres.gov.co/BDUA/Estadistica-BDUA/Reporte-Afiliados-Por-Entidad

4. Codes 130120, 130208 and 132212 according to the EPS classification established by the National Superintendency of Health

5. See blogs: https://www.neuroeconomix.com/los-techos-en-el-sistema-de-salud/https://www.neuroeconomix.com/la-evolucion-de-los-presupuestos-maximos-en-salud/

6. Codes 1301, 1302 and 1322 according to the EPS classification established by the National Superintendency of Health

7. Codes 3501 and 3230 of the revised information.

8. The full report can be found at: https://docs.supersalud.gov.co/PortalWeb/SupervisionRiesgos/EstadisticasEPSRegimenContributivo/Boletin

9. See judgment SU-480 of 1997 of the Constitutional Court.

 

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