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1. THE GREAT TRANSFORMATION OFTHE HEALTH SYSTEM IN 2020
There isa verypowerful change,whichcallsustoreview the wayinwhichwe structure the financingof
the differentbasketsof servicestowhichwe Colombiansare entitled.
The newsthat iscurrentlymakingheadlinesisthe pandemic,withitsfourwavesandthe highsectoral,
social and institutional coststhatitleavesus;Butbeyondthat, there isa verypowerful change,which
callsus to reviewthe wayinwhichwe structure the financingof the differentbasketsof servicesto
whichColombiansare entitled,andthe relationshipsbetweenthe differentstakeholders,andwe are
talking,of course,yes,of the start-upof the mechanismcalledMaximumPMBudgets.
ORIGIN OF THE TRANSFORMATION
During2018 and a good part of 2019, the governmentandthe governmentalinstitutionshadwell-
foundeddoubtsaboutthe economicsustainabilityof the healthsystem, areasonthatpromptedthe
inclusionof twomechanismswithinthe National DevelopmentPlan(Law 1955 of 2019) that Theyaimed
to resolve thisriskinthe background:the firstso-called"endpoint"thatfounddebtsincharge of the
State for about$ 6.7 billion,andof which$1.5 billionhave alreadybeenpaid;andthe topicthatdoes
not occupytoday,the "MaximumBudgets - PM" definedinresolutions205 and206 of 2020.
HOW'S THE END POINTGOING?
As we have alreadysaid,during2019 around $ 1.5 billionwereturnedover,amongwhose paymentsthe
followingstandout:
$ 514 billionowedbyCaprecom
$ 172 billiontransversegloss
$ 349 billioninadvance paymentadjustedtoIPS
$ 220 billionprepaymentadjustedtoEPS
VERIFICATION PROCESSRECOGNITION ANDPAYMENTOFTHE END POINT
Making itclearthat the government'scommitmentisstill farfrombeingfullyfulfilled,itisnolesstrue
that the institutionalgallantrythatinvolvesagiganticinternational publicdebttomeetthe obligationis
verywell seen,andurgentlyrequired.

2. To advance the process,ADRES,throughResolution2707 of 2020, adoptedthe Operational andAudit
Manual,whichdescribesthe stagesandstepsthatmust be carriedout to organize,present,reviewand
verify,validate,recognize andpayforservicesandhealthtechnologiesnotfundedbythe UPC.
The other normsthat frame the participationof the actorsthat wouldbenefit(providers,OL,suppliers,
pharmaceutical industryandEPS) are:
Circular025 of 2020 - Schedule
Resolution618of 2020 issuedbythe Ministryof Healthand Social Protection,
Decree 521 of 2020
Decree 800 of 2020
THE MAXIMUM BUDGETS
Article 240 of the aforementionedLaw1955 of 2019 (PND),encompassesthe conceptof Maximum
Budgets-PMwithinafinancial linecalled spendingefficiency.
Alreadythissurname,distancesusfromresultsandqualitiesthatthe sectorwouldquicklydemand,but
it wouldputuson the otherhand, intune withthe true sector transformation:the centralizationof the
resourcesof the healthsector,andits integral managementincharge of the EPS.
The simplicityof the methodological designisperhapsitsbestargument:anational collectionof data
fromthe MIPRES tool andthe operationof the territorial entities,toestablishabaseline of patients/
users,technologiesused(quantities) andtheirstandardizationbasedonminimumunitsof contraction
of relevantgroupsandprojectionsof usesforthe nexttwoyears,whichmade the emergence of adelta
indispensable (whichwouldcoverthe riskinherenttomathematicalsuspicion);finallythe incorporation
of the VMR - MaximumRecovery/CollectionValues,whichwouldestablishthe purchasingpowerof
thisceiling.
The resultwas a technical regulationforcoverage by the PMs,and a resource allocationtablethat
totaled$ 3.9 billionfortenmonthsof operation,distributedinunequal partsbetweenEPSof the
contributoryregime ($3.3 billion),andEPSof the subsidizedregime.($594 billion).

3. It isworth clarifyinghere thatthe subsidizedinsurance withcut-off toJune 2019 covers24,307,637
people (itgrewby1.5 millionpeople in6months),whilethe contributoryscheme enrolls22,065,702
Colombians(itdecreasedsomewhatmore of 900 thousandpeople inthe last 6 months).
FINANCIAL RESOURCES FROM MAXIMUM BUDGETS
Thisnoble operationbringsotherunremarkablebenefitssofar;The firstis the financingalready
obtainedforthe resourcesandtheirplacementinthe ADRES,whichtherebyachievesample funding,
and an unprecedentedavailabilitytopayforthe servicesnotfinancedbythe UPC.
The secondwouldundoubtedlybe the correctdecisiontomake advance transfersof these resourcesto
payers(EPS),a situationthatina pandemicresultedinacataract of resourcesthatanticipatedMarch,
April andMay.
The third,alreadytitledbefore,isthe financial concentrationinthe EPSthat now receive,contractand
pay forthe servicesof collective protection(previouslycalledhealthbenefitsplanorPOS),and
individualprotection(previouslycallednoposorno pbs).
The month of March 2020 will marka before andafterinthe Colombianhealthsystem;the resources
transferredtothe EPS had neverreachedsuchheights:
https://www.softwaremedico.com.co/la-gran-transformacion-del-sistema-de-salud-en-el-2020/