Colombian Healthcare: State Intervenes in EPS Famisanar

The Health Promoting Company (EPS), Famisanar, has been intervened by the State. Amid the ongoing debate over healthcare reform in Colombia, which has stirred controversy, the government has decided to intervene in one of the largest healthcare service providers.

Famisanar, along with Sanitas and Compensar, is one of the largest EPS currently operating in the country. Both company and government sources have informed the over one million users that this intervention is aimed at ensuring the responsible provision of service and should not negatively impact any of the users.

Forced Intervention

The Superintendence of Health, the state body responsible for regulating the proper functioning of the healthcare service in Colombia, has decided to intervene in the EPS Famisanar with the goal of bringing order to the company’s operations.

“The forced intervention of the EPS Famisanar at the national level has been ordered for a period of one year after evidence of deteriorating financial indicators, user complaints, and the failure to meet more than 10 accreditation standards,” wrote Supersalud in its statement.

Over 60,000 Complaints in 6 Months

Famisanar has accumulated over 60,000 complaints from its policyholders in the first 6 months of the year due to poor service, delays, and lack of attention. Regarding the state’s intervention, the administrators of Famisanar, in a statement posted on social media, have stated that the “measure is primarily aimed at strengthening and improving our management capacity, with the purpose of continuing to provide quality service and benefits to our policyholders, employees, strategic allies, and all our stakeholders.”

Likewise, the new leadership of the company, which has the majority of its users in the central region of the country, has wanted to convey a message of reassurance. “We want to convey a message of tranquility and confidence in this process. EPS Famisanar remains committed to its mission and vision to ensure the provision of healthcare services to our policyholders,” signed Sandra Milena Jaramillo, special intervening agent of Famisanar.

A System Under Review

The intervention in Famisanar comes at a time when the healthcare model in Colombia is being debated. The long list of EPS that have been intervened to save their accounts or have disappeared, leaving behind accounting irregularities or outright embezzlement, has been a recurring issue since the inception of the model.

The system was implemented in 1990 through Law 100/1990. Under this scheme, EPS are responsible for enrolling individuals, registering them in the general social security healthcare system, and collecting the mandatory contributions from workers and employers to access healthcare services.

The law was passed 33 years ago by then-Senator Álvaro Uribe, who later served as the country’s president for two terms (2002-2010). The system is a mixed one and is financed partly by user contributions and partly by the government. It’s worth noting that the government’s share of financing the healthcare system is substantial, covering most of the services that cannot be paid for by worker or employer contributions alone.

EPS in Liquidation or Under Supervision

Before the intervention in Famisanar, there were already 16 EPS in liquidation and 10 others under supervision in Colombia. These entities collectively affect 7.8 million policyholders, with an estimated total deficit of around 5 trillion Colombian pesos.

SaludCoop and Cafesalud, the Most Serious Precedents

SaludCoop became the largest EPS in Colombia during its existence. It had 5,204,000 policyholders, which in 2009 accounted for nearly 24% of Colombia’s population. Problems began in 2011 when a deficit was detected in SaludCoop, resulting from delays in the payment of public resources. Irregularities in the company’s management were also uncovered, such as investments both inside and outside the country without financial support and even funding of a professional football team in the capital.

It was then that the government of President Santos ordered the intervention with the aim of saving the company. After 5 years of being under intervention, the liquidation of the EPS was inevitable, and the company ceased operations in 2016. The legal representative of SaluCoop, Calor Palaccino, was financially sanctioned in 2013. Although the criminal case was archived, a later reopening of the case led to Palaccino’s imprisonment in 2018, accused of embezzlement for the benefit of third parties. The EPS’s debt amounted to 1.4 trillion pesos.

Another similar case was CafeSalud, the EPS that was liquidated in 2019, leaving a debt of 90,797 million pesos. Irregularities were found in payments to service providers and corruption for diverting social security resources to other purposes not legally intended and overpricing of medications.

Ministry of Health Commits to Pay Its Debts

For its part, the Minister of Health, Guillermo Alfonso Jaramillo, pledged that his ministry will pay the debt it owes to the EPS to ensure the viability of the system.

In a meeting with GestarSalud, the association that represents the EPS in the subsidized regime, i.e., those paid for by the state, the minister committed to ensuring that the funds due for the months of June, July, August, and September would arrive soon

“We have a financial respite because the resources that were delayed for the months of June, July, August, and September are coming. Now, another important issue that we need to analyze is clarifying the claims for the year 2022 and what has happened in 2023 so far. That’s under study,” said Galo Viana, CEO of GestarSalud, who confirmed the minister’s commitment to paying the debt.

Furthermore, the representative of the EPS pledged support for healthcare reform, while advocating for the role of the companies that the association represents in the current and future healthcare system in Colombia.

“We reaffirm our commitment to a healthcare reform that can benefit users by allowing them to navigate through different services and institutions with the support of EPS. We also aim to assist the government in rationalizing the use of resources to create a healthcare system that is user-friendly and financially sustainable,” clarified Viana.

The Debate Continues

Thus, the debate on the reform of the healthcare model remains open and more interesting than ever. After the government’s initial attempt failed, the new minister is working to secure the necessary support in the chambers to reach an agreement that will stabilize a system under review.

For now, there are more disagreements than agreements among different political parties and the companies themselves that, as of today, are still responsible for providing services to citizens.

Nevertheless, there is a general consensus in civil society that the system must be improved to ensure its survival. The direction the new model will take is still to be defined and will need to be agreed upon in the Colombian legislature.