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financiación del aseguramiento

The financing of insurance in the Colombian health system

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

These days, the discussion about reducing the amount of the national budget allocated to health, which partially finances the subsidized regime, has become relevant.

It has come as a surprise that this is the first time that, instead of requesting more resources, national government officials consider that less is required.

Without ignoring that it is a complex issue and admits multiple interpretations, below, we carry out the analysis of the financing of the insurance for the year 2022, breaking down the main income and expense items established in the budget of the Administrator of the Resources of the General System of Social Security in Health (ADRES) for both schemes, as well as the execution of said items.


The tax system


As of August 31, 2022, the members of this regime were 22,990,807[1].


Of these, 13,587,582[2] are contributing members and 9,133,225 are beneficiary members, that is, dependents of those who contribute.


Multiplying the number of affiliates by the average value of the Capitation Payment Unit (UPC) of the contributory regime for this year, which is $989.712, as determined in Resolution No. 2381 of 2021 issued by the Ministry of Health and Social Protection, yields a result slightly higher than $22.7 billion that would be required to finance all the UPCs of the contributory regime.


However, it must be taken into account that the calculation of the value necessary to finance the UPCs was made taking into account the average, without including any of the adjustments established in the aforementioned resolution, which, like the values for each age group, modifies the amount necessary to finance said units.


When reviewing the budget found on the ADRES page[3], we find that for the year 2022 revenues of 1TP2Q24.5 billion were included for contributions in the contributory regime, of which as of August 31, $17.5 had been received. billion (1TP2Q2.19 billion monthly).


The money budgeted and collected to finance the contributory regime includes the contribution of the exception regimes[4], the additional UPCs[5] and the solidarity contribution[6].


In relation to executed expenses, the definitive budget for the UPCs of the contributory regime in 2022 is $30.5 billion, of which $21.7 billion have been executed as of August 31, 2022.


The difference between income and expenses is explained, among others, by the budget additions that have been necessary to assume payments for the pandemic, that is, the financing of the contributory regime, in addition to contributions, includes other resources necessary to meet the COVID-19 emergency.


In the same way, it is important to consider that the expenses of the contributory regime must include the interventions, activities and procedures not included in the health benefits plan, called maximum budgets, for which $1.5 billion were included and have been executed. to the aforementioned date, a little more than one billion pesos.


Subsidized regime


By means of the same analysis carried out for the contributory, we have that the affiliates to the subsidized regime on the same date were 25,509,128. When multiplying that number by the value of the average UPC of the subsidized established in resolution 2381 mentioned above ($927.723.6), it results that to finance the UPCs of this regime, $23.7 billion would be required.


As for the contributory regime, the calculation of the value necessary to finance the UPCs was made taking into account the average without including the adjustments, therefore, the final value may vary when calculating that amount necessary for each UPC according to the age groups and the aforementioned adjustments established in the repeatedly mentioned resolution.


According to the ADRES budget, the income to finance the subsidized regime would be mainly the following:

financiación del aseguramiento


The income for the financing of the subsidized regime totals $34.6 billion, of which $25 billion have been collected as of the date of the study.


On the other hand, the budgeted expenditure for the UPC of the subsidized regime is 1TP2Q29.4 billion, and its execution to the date so often mentioned is 1TP2Q19.7 billion.


To these expenses must be added the interventions, activities and procedures not included in the Health Benefits Plan (PBS), for which a little more than $721 billion were budgeted, executing on the same date in August, $341 billion.


The insurance financing


The figures shown above show that the financing of insurance in the health system is mixed, in the contributory regime it comes from the contributions paid by employers, employees and self-employed. In the subsidized regime, financing comes from taxes and the main item is contributions from the nation, that is, from the national budget.


Consequently, any reduction in the contributions of the national budget will have repercussions, mainly on the financing of the subsidized regime, without said affectation having a significant impact on the contributory regime.


The budgeted expenses exceed the income received from contributions to finance the contributory regime, so it must be understood that there are additional items to these, such as those that have been appropriated to attend to the pandemic, which are different from the UPCs, but are part of the expenses. of this regimen.


Finally, it deserves special consideration that only 13,587,582, of the 48,499,935 members of both schemes, pay their health contribution, that is, the rest, 34,912,353, do not make any expenditure to finance the system.


This implies that only 28% of those affiliated to the health system make any payment for its financing, which demonstrates the need to improve controls that prevent the evasion of contributions and reduce the avoidance of said payments, in order to give a better financial solidity to the system.


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1. Font: https://www.adres.gov.co/eps/bdua/Paginas/reporte-afiliado-por-departamento.aspx

2. Source: social protection information system (sispro.gov.co)

3. https://www.adres.gov.co/nuestra-entidad/informacion-financiera/unidad-de-recursos-administrados-ura/presupuesto

4. Teachers, military forces and Ecopetrol.

5. Corresponds to payments made by affiliates for people who are not part of their family nucleus, for example, grandparents who have included their grandchildren as affiliates.

6. It is a membership mechanism through a special payment for those who cannot join the taxpayer and their SISBEN classification does not allow them to access the subsidized

7. Corresponds to income received as of August 31, 2022.

8. Corresponds to the resources that the Nation collects through taxes and must transfer to the territorial entities (Departments, Districts and Municipalities) in compliance with articles 356 and 357 of the Political Constitution

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