La deuda con la salud: Presupuesto para hospitales públicos es insuficiente

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La mayoría de los servicios que reclaman los usuarios no se encuentran en el plan de beneficios.

Lo que necesita este sistema de seguridad social en materia de salud

Redacción política

Buena parte del presupuesto nacional con vigencia para el año 2019, se va para el sector salud. Sin embargo, pocos son los recursos destinados para el pago de la deuda de los hospitales públicos en Colombia que han venido haciendo llamados de urgencia por cuanto pueden terminar con un final fatal, cerrar por falta de dinero para su funcionamiento.

La deuda que tienen las EPS para con los hospitales públicos asciende a casi ocho billones de pesos por servicios prestados. Es decir, las EPS firman convenios para que, una vez autorizados, sean atendidos en los hospitales públicos. El drama de las instituciones públicas de salud golpea a la población más vulnerable de Colombia.

Los ciudadanos de estratos uno y dos, no son los únicos que acuden a los hospitales públicos buscando tratamientos a sus afectaciones, mayoritariamente se reclaman servicios generales o de especialistas en los hospitales públicos la población que cotiza en régimen de salud privado a manos de las EPS.

VOZ analizó los datos que entrega la Asociación de Clínicas y Hospitales de Colombia a una semana para que el presupuesto nacional quede aprobado por el Congreso de la República y los hospitales entren en cuidados intensivos para sobrevivir al menos el siguiente año.

Según la Administradora de los Recursos del Sistema General de Seguridad Social en Salud, Adres, entidad que se encuentra a cargo de las funciones del Fogafín o Fondo de garantías para la prestación de la salud, giró $201.162 millones por los servicios no incluidos en el Plan de Beneficios en salud a las EPS. La respuesta de los dueños de las EPS es que no son recursos suficientes.

En Colombia por cada 10 pesos del sistema de salud nueve son producto del pago de la Unidad por Capitación, es decir, el servicio que cancela el Estado a las EPS, y un peso va destinado al pago de los servicios prestados por esas mismas EPS a los usuarios de procedimientos que no se encuentran en el Plan de Beneficios.

Con esos datos las EPS no tienen por qué alegar quiebra y por ende negar servicios de salud que de antemano les ha cancelado el Estado, que financia casi el 90% del costo de los servicios que prestan. Los dueños de las EPS le deben respuestas al país sobre los costos de administración de sus empresas y la intermediación de sus servicios.

La deuda con los hospitales y clínicas

Las deudas a los hospitales y clínicas, por los servicios de salud prestados a los usuarios del sistema de salud, llegaron a $8.2 billones de pesos, de los cuales el 60,2% es cartera en mora, así lo registra el estudio semestral con corte a junio 30 de 2017, realizado por la Asociación Colombiana de Hospitales y Clínicas en una muestra de 153 instituciones hospitalarias públicas y privadas.

Los deudores

Les deben las EPS del régimen contributivo 3.1 billones de pesos, que corresponden al 37,9% de la deuda total; las EPS del régimen subsidiado 2.5 billones de pesos, es decir el 30,2 % de la deuda; el Estado que incluye los entes territoriales, Asociación Colombiana de Hospitales y Clínicas – diciembre de 2017 con $480.238 millones, el Fosyga con $166.327 millones y otros $189.225 millones, concentra el 10,2% de la deuda. El 21.7% restante lo adeudan entidades de medicina prepagada y planes complementarios, aseguradoras SOAT, ARL, IPS, magisterio y empresas, entre otras.

Las EPS que más deben

En el régimen contributivo la mayor deudora es la Nueva EPS con $874.634 millones, seguida por Coomeva EPS con $587.309 millones y Cafesalud EPS con $373.104 millones. En el régimen subsidiado el mayor deudor es Savia Salud EPS con $626.893 millones y la liquidada Caprecom EPS con $251.047 millones; respecto a los entes territoriales el mayor deudor es el departamento de Antioquia con $147.631 millones.

La deuda total de 50 entidades de los regímenes contributivo y subsidiado, que están en liquidación, intervención, sometidas a la medida cautelar de vigilancia especial, en programa de recuperación, o liquidación voluntaria, es de $3.1 billones de pesos de los cuales 68.4% es cartera morosa. En este grupo de EPS con medidas especiales está el 50,8% de los afiliados al sistema de salud colombiano, es decir 23.4 millones de afiliados aproximadamente.

El crecimiento de la construcción hospitalaria

Según el Censo de Edificaciones del DANE, que determina el estado actual de la actividad edificadora en Colombia, desde el cuarto trimestre de 2014 al tercer trimestre de 2017, la construcción con destino hospitales viene cayendo de manera significativa; el “Área total en proceso” pasó de 857.851 m2 en 2014 a 449.621 m2 en 2017, es decir una variación negativa del 47,6%.

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