The financial health of the EPS of the contributory regime
Francisco Jose Garcia Lara
Surgeon and Master in Health Administration
from the Javeriana University
Columnist of the newspaper La Nación de Neiva
A large part of Colombians consider that EPS is a big business and that a significant part of its profits are obtained by the denial or delay in the authorization of services.
In order to verify the veracity of said judgment, and taking the information from the financial statements of the EPS of the contributory regime that is found on the website of the National Superintendency of Health as of December 31, 2019 , they were carried out some observations on the financial situation of the EPS of the contributory regime, the results of which we present below.
Actives and pasives
Regarding assets , the following table was prepared, which includes the first seven in terms of amount:
Regarding liabilities , the first seven are also presented:
A simple analysis allows us to show that assets are lower than liabilities, the most significant difference being in Medimás and Coomeva.
Saludvida, which is not among the main ones with the largest assets, presents an even greater difference, since it had liabilities for $1,239,384,053,540 and assets for $327,170,241,582.
It is important to bear in mind that the EPS record invoices that have been audited and accepted as liabilities, that is, those that are in the audit process or have not been accepted are not reported in the revised information, which would imply that the liability EPS should eventually be higher.
Accounts receivable from ADRES
One of the main excuses of the EPS for not canceling the debts with the IPS and suppliers, is that the government, through the ADRES, owes them large resources.
Therefore, the data in the Superhealth information mentioned above were searched in relation to the amount owed for services or technologies not included in the Health Benefits Plan (No. PBS before No POS) , finding the shown below, again of the seven EPS with the highest accounts receivable for this concept:
Of the debt described above and reported by the EPS to the Superhealth, Compensar reports a value of zero for this concept, without being able to specify the reasons for this figure.
This debt represents a little more than a third of the previously reported liabilities, without including the amounts pending payment for compensation or maternity leave payments, which are also in charge of the ADRES.
With the aim of making a comparison between what is owed to the EPS with what they in turn owe to IPS or providers for No PBS , it was found that only three EPS reported the information. In the others, the information found is zero, without again being able to specify why this figure is reported.
The three EPS that reported the aforementioned debts are:
The first two show that the amount owed by the ADRES is significantly higher than the amount owed by the EPS to IPS and suppliers for the same concept.
Regarding the results , these were divided into two: the EPS that reported losses which are accumulated with previous years, and those that gave profits corresponding to the year 2019.
The main ones that report accumulated losses are the following:
And those that reported profits are:
It is reiterated that the losses are accumulated because they better reflect the financial reality of the EPS, and regardless of the fact that some of the EPS that have been showing losses in previous years could have made profits in 2019, they could not cover the negative value of the years previous.
The EPS that reported profits if they correspond to the year 2019, and in the revised information it was evidenced that they are not dragging losses.
After adding the losses and subtracting the profits, a result of total losses for the EPS of the contributory regime of $-3,761,255,908,620 is obtained.
MINIMUM CAPITAL AND ADEQUATE EQUITY
In addition, the National Superintendency of Health presented the preliminary evaluation report on compliance with the minimum capital and adequate equity indicators (effective 2019 ).
As a summary of said report, the following table is presented, which shows compliance or not with the minimum capital and adequate equity indicators:
The table shows some EPS that had not been mentioned before, such as EPM, Comfenalco Valle, Saludmia and Ferrocarriles, which due to their size were not significant in the previous points.
It should be noted from the report that the vast majority of the EPS of the contributory regime comply with the minimum capital and adequate equity. Medimás, SOS and Saludvida do not comply with either of the two; while Famisanar, Saludmía and Ferrocarriles do not comply with the adequate patrimony.
Are EPS really such a good business?
By way of conclusion and based on the data presented above, which is reiterated are taken from the official information registered on the website of the National Superintendency of Health, the answer to the question posed is a resounding no.
Regardless of the fact that several of the EPS of the contributory regime may have collateral businesses, such as their own IPS or belong to a group that possibly obtains some type of profit in collateral activities, insurance as such does not seem to be a big business.
It is essential to highlight that there are EPS that give profits, which leads to think that the insurance business in some cases can be profitable, however, these profits are negligible compared to the large losses in the sector.
Nor should it be forgotten that there may be mismanagement in some of the entities, in fact, in 2019 the liquidation of three EPS of the contributory regime was ordered: Cafesalud, which since 2017 did not operate as such, Cruz Blanca and Saludvida.
On the other hand, taking into account that in accordance with article 155 of Law 100 of 1993, the EPS are administration and financing agencies of the General System of Social Security in Health, the financial situation of these entities shown here, puts in serious risk to the entire system, since the crisis affects the other actors in it.
It is important to mention that other financial indicators were not calculated because the situation shown and the mere comparison of assets versus liabilities, added to the losses presented, make it practically unnecessary to do so, since the delicate financial situation of the vast majority of EPS obvious.
Special emphasis should be placed on the debt of the ADRES with the EPS for No PBS, which as explained before, is one third of the liability of the EPS of the contributory regime and whose figure is higher than what is budgeted by the government in the so-called agreement end point .
This situation most likely prevents the National Superintendency of Health from requiring the EPS to pay the IPS and providers, since the debt chain originates in the State. In other words, the argument of the EPS for not paying their debts is not a simple excuse but a reality, and being an original sin of the State, it is very difficult for the inspection, surveillance and control entity to demand that the EPS comply .
Finally, it must be taken into account that the financial crisis of health systems is global, aggravated in Colombia by a PBS, which added to the No PBS, makes the benefits covered with public resources practically unlimited, even if there are a few exclusions.
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2. Code 1 in the information of the National Superintendency of Health.
3. It is classified in the information of the National Superintendence of Health as EPS of the subsidized and contributory regimes.
4. It is classified in the information of the National Superintendency of Health as EPS of the subsidized and contributory regimes
5. Code 2 in the information of the National Superintendency of Health.
6. Administrator of Resources of the Social Security in Health, before the Solidarity and Guarantee Fund (FOSYGA).
7. Code 130205 in the information of the National Superintendency of Health.
8. Code 210607 in the information of the National Superintendency of Health.
9. Code 35 in the information of the National Superintendency of Health.
11. See blog: https://www.neuroeconomix.com/los-avances-del-acuerdo-de-punto-final/