The financial health of the EPS of the subsidized regime
Francisco Jose Garcia Lara
Surgeon and Master in Health Administration
from the Javeriana University
Columnist of the newspaper La Nación de Neiva
As a complement to the previous blog , and taking in this case the information as of December 31, 2019 from the financial statements of the EPS of the subsidized regime that can be found on the website of the National Superintendency of Health , Here are some observations on the financial situation of the aforementioned entities.
Actives and pasives
Regarding assets , the following table shows the first nine EPS-S in amount:
Regarding liabilities , the first nine are also presented:
A simple analysis allows us to show that the assets of the first nine EPS-S correspond to practically half of the liabilities, the most significant difference being found in Asmet, Emssanar, Saviasalud and Capital Salud. Regarding the latter, it should be remembered that they are mixed with predominantly public capital.
Coosalud is the only one that has a higher value of assets than of liabilities.
It is important to reiterate that the liabilities are possibly higher, since the EPS-S record as debt the invoices that have been audited and accepted, that is, those that are in the audit process or have not been accepted are not reported in the information. revised.
Of the assets, it was reviewed how much accounts receivable represented, finding the following:
Taking into account the figures for assets shown above, two-thirds are accounts receivable, that is, they not only have higher values of liabilities over assets, but also that the highest percentage of the latter owes them.
As with what was done for the contributory regime, the information on accounts receivable was sought by the so-called No PBS , finding that not all EPS reported the information, and the first nine of which reported the aforementioned debts are:
Unlike the contributory regime, in the subsidized regime these debts correspond to the territorial entities (department and districts) until the issuance of the Development Plan 2018 -2022 (May 25, 2019)  which must be assumed by ADRES  . As of the issuance by the Ministry of Health of Resolution No. 205 of 2020, the No PBS is assumed by the EPS for the so-called ceilings or maximum budgets .
Regarding the results , these were divided into two: the EPS that reported losses which are accumulated with previous years, and those that obtained profits corresponding to the year 2019.
The main ones that report accumulated losses are:
And those that reported profits are:
It is insisted 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 are not enough to cover the negative value of the previous years.
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, it yields a result of total losses for the EPS of the subsidized regime of $-5,014,508,551,044.
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 above shows that only three EPS meet the minimum capital and adequate equity (Cajacopi, Comfachocó and Mutual ser) the others do not meet either of the two.
Coosalud was not included in the report because its data was under review.
Possible causes of financial situation
The financial data of the subsidized regime, which is insisted on are taken from the official information registered on the website of the National Superintendency of Health, show that financially the EPS of the subsidized regime are in a worse financial situation than their counterparts in the contributory regime.
For this case, it should be considered that for 2019 the Capitation Payment Unit (UPC) of the contributory regime was set at a value of $847,180.80, while the UPC of the subsidized regime was determined in $787,327.20 [14 ], a difference of $59,853.6.
It is important to specify that the Compulsory Health Plan (POS, today the Health Benefits Plan or PBS) of the subsidized regime and the contributory regime is the same since July 2012, therefore, the EPS of the subsidized regime receive less than those of the regime. contributory for doing the same.
On the other hand and taking into account that, in 2019, according to information from the Integrated Social Protection Information System (SISPRO), the affiliates to the subsidized regime were on average 22,800,485, a figure that multiplied by the aforementioned difference represents a difference of $1.364 trillion that received less EPS from the subsidized regime compared to what they should have paid if the value of the UPC was equal.
It is not necessary, then, to do a deep analysis to understand that for more than 8 years the EPS of the subsidized regime have been receiving less money than those of the contributory regime, and this is undoubtedly one of the main causes of their financial crisis.
It is important to note that the vast majority of EPS of the subsidized regime are non-profit or mixed entities, and in some cases, losses are putting the assets of their parent companies at risk, as is the case of family compensation funds.
As in the contributory regime, there are EPSs that give profits, which leads us to consider that in some way better results can be achieved. However, these profits are minimal in the face of large losses in the sector.
Additionally, we must emphasize that the EPS of both regimes cannot avail themselves of the insolvency measures established by Law 1116 of 2006 and complementary ones, since the norm that applies in these cases is the Financial Statute, which does not include measures of business reorganization or similar that allow reaching agreements with suppliers and debtors to resolve this type of financial crisis.
Finally, we insist that the financial crisis of the health systems is global, aggravated in Colombia for the subsidized regime with a differential payment and less for doing the same as in the contributory regime.
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- The financial health of the EPS of the contributory regime
- Law of ceilings in the health system
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3. Code 1 in the information of the National Superintendency of Health.
4. Code 2 in the information of the National Superintendency of Health.
5. CCF is short for Family Compensation Fund.
6. Code 13 in the information of the National Superintendency of Health
7. Activities and technologies not included in the Health Benefits Plan, before the Mandatory Health Plan or No POS.
8. Law 1955 of 2019.
9. Administrator of Resources of the General System of Social Security in Health.
10. See the blog on the page: https://www.neuroeconomix.com/los-techos-en-el-sistema-de-salud/
11. Code 35 in the information of the National Superintendency of Health.
13. Classified in the report as EPS of both regimes.
14. See Resolution No. 5858 of 2018 issued by the Ministry of Health.