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MIPRES

What is the MIPRES and how is its implementation going in the subsidized regime?

Foto-Laura-Van-ConvertImage

Laura van der Werf Paintings
MSc
MBE Researcher
NeuroEconomix

Many health services and technologies are not covered by the health benefits plan. Previously, these drugs were formulated using a non-POS format and later a scientific technical committee (CTC) was held. This cumbersome process to access non-covered services and technologies was eliminated. Now, for the formulation of these services and technologies, a technological tool called MIPRES is used. What is the purpose of this technological tool? Why was it created?

The formulation of services, drugs and other health technologies that were not covered by the Obligatory Health Plan (POS) was for many years a source of problems for the health system. A few years ago, so that its financing could be done with public resources, it was necessary to carry out a complex procedure. This procedure included going through a scientific technical committee (CTC), which reviewed the relevance of the service or technology formulated. The CTC was a body made up of doctors and administrative officials from each EPS that was in charge of determining whether or not what was formulated was considered pertinent.

 

mipres2Many medications and procedures were disapproved by these CTCs, so patients very often resorted to guardianship to access what had been denied. This led to this legal resource being constantly used to obtain non-POS medications and services. Reaching a maximum in 2008, the year in which 121,059 guardianships were filed that invoked violations of the right to health (1).

 

Another criticism of the procedure for the authorization of services, medicines and other technologies through the CTC was the lack of medical autonomy. The procedure made the formulation of the health professional subject to authorization by professionals and administrators of the EPS who had not been in contact with the patient.

 

Lack of systematicity ...

On the other hand, the lack of systematic information made it difficult to monitor the formulation of non-POS drugs and services. For this reason, it was difficult to detect situations of corruption, such as the so-called “hemophilia cartel”.

 

 

mipres3Statutory law 1751 of 2015 regulated the fundamental right to health. In this it was determined that the health system would guarantee this right through the provision of services and technologies. These were structured on a comprehensive conception of health, including promotion, prevention, palliation, care of the disease and rehabilitation of its sequelae. In addition, in its article 17, it determined that health professionals must be guaranteed the autonomy to make decisions about the diagnosis and treatment of the patients in their care. Thus prohibiting any constraint, pressure or restriction of professional practice that would undermine professional autonomy.

 

Changes in the way of understanding health and professional autonomy led to several modifications in the organization of the health system. Thus, the POS was replaced by the health benefits plan charged to the capitation payment unit (PBSUPC) (see: https://www.neuroeconomix.com/nuevo-pos-que-fue-lo-que-cambio/), a list of drugs and technologies that cannot be financed with public resources was defined. Likewise, a new procedure was defined for access, prescription reporting, supply, verification, control, payment and analysis of information on health services and technologies not covered by the PBSUPC.

 

What is the MIPRES?

In order to face the problems that existed with the formulation of non-POS drugs, the new procedure had to eliminate the administrative barriers that made it difficult to access health services and technologies not covered by the PBSUPC.

 

Furthermore, to safeguard the right to health and professional autonomy, the prescription of these services and technologies should be able to be carried out directly by health professionals. This without requiring approval by a CTC.

 

Likewise, it was necessary for the new procedure to allow the verification, control, payment and timely analysis of the information. To achieve these objectives, it was determined that the new procedure would be carried out through an application that would operate through the technological platform of the Comprehensive Social Protection Information System (SISPRO) with online completion.

 

mipres4MIPRES is the technological tool that was created for this purpose. It allows authorized health professionals to report the prescription of health technologies not financed with UPC resources or complementary services. They can be used as prescribers by professionals in medicine, dentistry, and optometry. Nutrition professionals can use it to order nutritional support products once they have been prescribed to the patient.

 

 

The implementation of the MIPRES and the MIPRES for the subsidized regime

The MIPRES became compulsory in April 2017 for the contributory regime (2). It is currently regulated for this regime by resolution 1885 of 2018 (https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/resolucion-1885-de-2018.pdf). For the subsidized regime, the use of this tool has taken longer, since each of the territorial entities must carry out a procedure to be activated in the application.

 

This is due to the fact that for the subsidized regime the services and technologies not covered by the PBSUPC are financed with resources from the territorial entities. While for the contributory regime they are financed with resources administered by the Administrator of Resources of the General System of Social Security in Health (ADRES).

 

 

Resolution 2438 of 2018

According to resolution 2438 of 2018 (https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/OT/Resolucion-2438-de-2018.pdf), all territorial entities had to be activated in the application no later than January 1, 2019. However, by December 2018 only one territorial entity was activated (Nariño).

 

According to the territorial entities, this was due to operational, administrative and technical difficulties derived from the operation of the tool. As well as the adjustment to the procedure for recognition, verification and payment of health technologies not financed with UPC resources necessary for activation. For this reason, an extension was given to the territorial entities for activation in the application until April 1, 2019 (Resolution 5871 of 2018 https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/OT/resolucion-005871-de-2018.pdf).

 

Despite the fact that this deadline has already passed, only 26 of the country's 32 departments and three districts are active in MIPRES (3). As long as these territorial entities are not activated, the CTC continues to be the mechanism used, which is why it continues to constitute a barrier to access services and technologies for a proportion of the patients of the subsidized regime.

 

Can a technological tool solve all problems?

The MIPRES seeks to improve the prescription, verification, control, payment and timely analysis of information on services and technologies not included in the benefits plan. In order to achieve these objectives, it may be useful to take into account factors that are related to the success in the implementation of information systems.

 

A first consideration is that there is often a significant gap between the design of information systems and the context in which they have to function in reality (4). This could explain the difficulties in implementing the MIPRES for the subsidized regime. It is important to evaluate whether the application design is suitable for the context in which it is required to function.

 

Another important factor that must be taken into account is the balance that must exist between the control functions and the clinical functions of the system (4). It is important that the system allows obtaining sufficient information for the verification, control, payment and timely analysis of the information, without hindering clinical practice.

 

In conclusion…

Finally, it is necessary to understand that the way in which this technological tool will be applied will depend on the way in which the different actors of the system interact with it (5). It is necessary to understand the origin of access barriers and corruption practices related to technologies and services not included in the PBSUPC in order to modify the behaviors of the system's actors and thus be able to meet the objectives for which this technology was developed.

References

1. Ministry of Health. TUTORSHIP IN HEALTH [Internet]. 2016 [cited 2019 Apr 28].

2. Ministry of Health. What is the Mipres application? [Internet]. 2017 [cited 2019 Apr 29]. Available from: https://www.minsalud.gov.co/Paginas/Que-es-el-aplicativo-Mipres.aspx

3. Ministry of Health. State of Activation of Territorial Entities Subsidized Regime [Internet]. 2019 [cited 2019 May 1]. Available from: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/OT/entrada-operacion-entes-territoriales-rsubsidiado-20190416.zip

4. Connell NAD, Young TP. Evaluating healthcare information systems through an “enterprise” perspective. Inf Manag. 2007; 44 (4): 433–40. DOI: https://doi.org/10.1016/j.im.2007.04.002

5. Doherty N, King M. From technical to socio-technical change: Tackling the human and organizational aspects of systems development projects. Vol. 14, European Journal of Information Systems. 2005. 1–5 p.

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jose yair gomez
11 months ago

The information is very interesting, every day progress is made and that is what you want.

OLGA CECILIA LADINO CÁCERES
1 year ago

Well, in my case it seems that because of the mipress I have had a problem to authorize me a drug that the Dr. formulated me, it seems that now that they are raising the formula for mipress, they do not accept it and reject it, I have been almost two years taking URSACOL 600 mg. and they had always authorized me, now that they upload it by mipress they reject it, like this: »the registered justification is insufficient to determine the type of disease that conforms to the therapeutic indications approved for the drug» the doctor cannot change that, he has always determined biliary cirrhosis disease, and I have always been authorized to do so. I don't know what to do, I can't stop taking that drug and it's very expensive.

amparo carrillo
1 year ago

The information is very interesting and what to do when the doctor refuses to ask because only specialists can do it, it has already happened to me.

Ruth Anchicoque Valencia
1 year ago

It is very important to know about all the rules of the health system.
Thanks

Juliana Sanchez
2 years ago

Interesting description.

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