Health & Insurance. 56
Colombia President Gustavo Petro and his Health Minister Carolina Corcho on February 13 unveiled a massive national health system “reform” proposal that is already setting off alarm bells in Congress, among health-system providers, health insurance networks, insurance buyers and future patients.
According to the proposal – now facing weeks of debate in Colombia’s splintered Congress – most of the existing “Entidades Prestadoras de Salud” (EPS) health-insurance networks here would be abolished -- and the few remaining (seven in total) would be gutted and gradually transformed into vaguely-defined service providers, rather than health-network organizers and service payers.
Still unclear in the proposal is what would happen to existing or future private-sector prepaid health insurance (PHI) and “complementary” health-insurance policies and programs -- the latter of which are just appendages to current EPS policies.
The issue: If the EPS networks eventually die, then so could the “complementary” policies -- and maybe even the PHI programs, according to some analysts.
Ominous language in the new Petro proposal potentially could gut the value of such policies by forcing all PHI or “complementary” policyholders to use the new, government-monopoly health system, at government-dictated service prices -- with all the inherent bureaucracy, availability constraints, political corruption and horrendous service delays that Colombians had suffered decades ago, under the old, pre-EPS health system.
Under a similarly disastrous government-monopolized health-care system now operating in Brazil, one-third of the entire Brazilian population has already fled the bureaucratic public health system, opting instead for private, PHI networks – fortunately still allowed by law there, but at relatively high cost.
Petro’s public unveiling of the “reform” proposal drew pathetically small crowds of a few hundred supporters at government-organized rallies this week (February 13 and 14) -- in contrast to the massive anti-Petro, anti-health-reform protest marches in many Colombian cities today (February 15).
That’s not a favorable sign for Petro’s proposed health legislation, despite Petro’s well-known reputation for inciting angry divisions, chaos and violence (as in the “Primera Linea” riots of 2021) with extremist, demagogic oratory, typically featuring straw-man “enemies” along with clever use of factual distortions and outright lies.
Colombia’s existing EPS-network system arose from the “Law 100” legislation of 1993 – promoted and led by Petro’s long-time nemesis, former Colombian President Alvaro Uribe. That 1993 law replaced what had been an historically chaotic, corrupt, vastly underfunded, government-monopoly Social Security health system.
Under that prior Social-Security system, only 22% of Colombia’s salaried workers were covered for health care services, while another 40% of the population had to stand in line for government-subsidized services, many suffering or even dying long-before getting any help.
In contrast, today 99% of Colombians are covered by various EPS health insurance networks – a system that would be replaced by a new version of government monopoly, accompanied by new local/territorial health-service “districts” that would be vulnerable to becoming new centers of political corruption, huge waste and lengthy service delays, according to Colombia’s National Academy of Medicine (“ANM” in Spanish initials).
In a public letter to Colombian Health Minister Corcho this month – signed by ANM and 13 other Colombian health-sector associations – ANM warned that under Petro’s proposal to replace EPS systems with new health-system “territorial entities,” these new entities “do not have the capacity to audit and review accounts or to review billing by event prior to payment, which constitutes an imminent risk of overbilling by some IPS [hospitals and clinics] that can lead to a depletion of resources, compromising the financial viability of all IPS and the guarantee of the right-to-care for all residents in Colombia.”
Colombia’s existing Administrator of Resources for Social Security Health Care (“ADRES” in Spanish initials) currently sends all collected health premiums from employers, workers and government welfare agencies to the EPS networks for subsequent payments to hospitals and clinics for patient services.
But under the Petro proposal, ADRES would replace all EPS payment systems, creating a government-payment monopoly, eliminating private-sector competition, hence stifling innovation and economy – and creating great risk of political corruption, ANM warns.
Under the new scheme of local health-system “territorial entities,” ADRES would pay hospitals and clinics only as directed by these new “territorial entities” -- members of which would be appointed or nominated by people who could be connected to corrupt Mayors and other local politicians, as in the prior, pre-1993 Colombian health system.
“Decentralization/deconcentration [of medical-service reimbursements to hospitals and clinics], which implies the appointment of managers, the formation of boards of directors and functional overseers of spending, must be carried out with the guarantee of preventing regional politicking and corruption. Audits should not be a function of ADRES. This must be done by an administrator/regulator,” according to ANM’s public letter.
“The forms of payment to health service providers must be defined, whether involving direct payment, or prospective global payment, etcetera. Other forms of contracting must be analyzed and arranged with the providers, including evaluation of health results,” the ANM letter warns.
Another section of the Petro proposal would require the creation of tens of thousands of new, territorial medical teams, currently non-existent. “The country must know the plan to meet the proposed goals in terms of the 20,000 territorial interdisciplinary medical teams,” ANM’s letter warns.
“A policy and resources for professional training and continuing education must be defined. A reform to the health system that does not contemplate a transformation of health education is incomprehensible,” the letter adds.
Currently, Colombia’s EPS organizations collect health-insurance premiums paid by companies and workers (the “contributory” sector) as well as government welfare payments designed to cover unemployed and unaffiliated workers (the “subsidized” sector). The EPS subsequently sends payments to hospitals and clinics to cover bills for services for both sectors.
But replacing the EPS networks with new, territorial health networks will cost at least COP$52 trillion (US$10.6 billion) under the Petro proposal, with nearly half of that cost hike (COP$25 trillion/US$5.1 billion) resulting from the creation of new primary-care health centers around the country.
Another COP$11 trillion (US$2.2 billion) would be required for new health-center infrastructure and COP$9 trillion (US$1.8 billion) for “formalization” and upgrading of health-care workers, under the Petro proposal.
Nowhere in the proposal is there any explanation of how to pay for these spending increases, although certain vague language in the proposal would authorize President Petro to make unilateral decisions to fund whatever programs he would like – a provision likely to provoke opposition in Congress.
Meanwhile, while Petro claims that too many Colombians suffer from poor service under the existing EPS networks, his massive, government-monopoly “reform” scheme eventually would destroy the entire existing system – its good parts along with the not-so-good parts -- rather than surgically remove or replace diseased portions with cures.
That’s like bringing a reckless, incompetent knucklehead as the surgeon into the operating room, using a sledge-hammer rather than a scalpel.
So: Welcome to Petro Health Care, where many fear the ideologically inspired “cure” could become worse than the disease.
Colombia President Ivan Duque and Health Minister Fernando Ruiz jointly announced this morning (April 25) that the face-mask mandate aiming to stifle the spread of Covid-19 will ease starting May 1, 2022 – but only in well-ventilated areas where at least 70% of the local population has gotten at least two vaccine doses and 40% have gotten “booster” (typically three) doses.
In addition, people won’t be required to show their “MiVacuna” Covid-19 vaccination card at entries to leisure sites and “mass” activities, according to the official government statement.
However, the mask mandate will continue “in classrooms, offices, churches, public transport, commercial establishments and places without direct ventilation,” according to the bulletin.
“These measures validate a message: we have been fighting this pandemic, not only doubling Intensive Care Units, strengthening the health system, but also achieving a massive, safe, free and equitable vaccination system,” President Duque added.
To aid public education, the Health Ministry will publish an official list of municipalities where local populations have achieved the 70% vaccination rate against Covid-19.
As for travelers 18-years-and-older visiting Colombia, “the recommendation is that they arrive in Colombia with a complete double-dose, or, in the case of the Janssen vaccine, a single-dose,” according to the bulletin.
“Those [travelers] who do not have complete schemes or are not vaccinated will require a negative PCR test that does not exceed 72 hours and may also present an antigen test that does not exceed 48 hours” before arriving in Colombia, President Duque added.
To date, Colombia’s Covid-19 vaccination coverage exceeds 83% of the population for first- and single-doses, 69.2% for complete (minimum two-dose) applications and 34.7% for booster (typically three-dose) regimes, Health Minister Fernando Ruiz added.
While Colombia had initially created 2,700 special points-of-vaccination against Covid-19 nationwide, “today there are 4,700 points, since vaccinations are being done in the country’s hospitals and clinics,” Ruiz added.
“In Colombia we have spent more than COP$15 trillion [US$3.8 billion] on this pandemic, and the health system was able to respond. Those [Covid-19] patients who wound-up in an intensive care unit [ICU] paid practically zero, and that is not everywhere. In other countries people had to pay millions to be in an ICU.”
In addition, the Health Ministry has now settled massive, historic debts that had been choking the finances of hundreds of hospitals and clinics nationwide – clinics that couldn’t collect anything from indigent patients or else didn’t get paid by some deliberately negligent or bankrupt health-insurance networks (“EPS” in Spanish initials), although many of those wobbly EPS networks have since been liquidated, he added.
Colombia’s Health Ministry revealed today (March 25) that nationwide vaccinations against Covid-19 have now totaled 80.2 million, with 34.6 million people now fully vaccinated.
Meanwhile, intensive care unit (ICU) occupation caused by Covid-19 cases has plummeted, enabling many more Colombians to have rapid access for other medical cases.
Of Colombia’s total 10,789 ICU beds available, only 201 of those beds today are occupied by people with Covid-19, according to Health Ministry vice-minister Germán Escobar Morales.
Meanwhile, Colombia continues to expand its Covid-19 vaccination campaign to various groups still lacking a second shot, as well as vaccinations for younger age groups.
Current vaccination rates are hovering around 300,000 doses daily, he said.
“The general panorama shows a positive trend in epidemiological terms and in hospital occupation, and in terms of vaccination, coverage is growing at a moderate pace, but we still face challenges in closing gaps” among younger age groups and anyone still lacking a second shot, Escobar added.
The department of Antioquia -- including Medellin and all its neighboring cities-- has just exceeded 10 million vaccinations against Covid-19, with 67% of the population here now completely vaccinated (in most cases, at least two doses).
This follows on the heels of a simultaneous announcement by Colombia President Ivan Duque that Covid-19 vaccinations nationwide already exceed 80% of the population, with a 70% complete-vaccination-rate fast approaching.
According to the February 18 joint announcement from Colombia’s Health Ministry, the Antioquia departmental government, Universidad Nacional, One Health Genomic Laboratory and Medellin-based electric-power distribution giant ISA (which cooperated in the efforts), Covid-19 vaccinations here have achieved better-than-world-class standards in just 12 months – often matching or even exceeding North American rates.
“With about 277 vaccination posts throughout the department, Antioquia has managed to apply up to 74,386 doses in a single day,” according to the joint announcement.
Antioquia Health Secretary Lina María Bustamante Sánchez added that “we have 83% coverage in first doses and 67% with a complete schedule,” resulting in a dramatic avoidance of Covid-19 hospitalizations and deaths – the latter almost exclusively occurring among the non-vaccinated.
“Where we have had the best rate of vaccination is in the Valle de Aburrá [Medellin metro], Oriente and Suroeste,” Bustamante explained. “In the most remote regions, with problems of public order and displacement, such as Bajo Cauca and Urabá, strategies were created to reach these territories. For that, we have had the alliance with ISA and Universidad Nacional, including a mobile vaccination unit and displacements by helicopters for special vaccination campaigns,” she added.
Commenting on the one-year anniversary of the vaccination campaigns, President Duque added that the government has already spent COP$4.5 trillion (US$1.14 billion) acquiring 104 million doses of Covid-19 vaccines, which are freely given to all residents here.
Since February 17, 2021, when the Covid-19 immunization process began, the national government has already supplied 75.7 million doses, resulting in 71% of all persons over 30 years of age now completely vaccinated.
Vaccinations also have reached the two-dose completion target for 51% of Colombians from 10-to-19-years-old, plus another 28% of children three-to-nine-years-old, according to a February 12 report from the Health Ministry. Childhood vaccinations are now rapidly increasing as Colombia returns to in-person schooling nearly everywhere.
Colombia Health Minister Fernando Ruiz announced this morning (January 24) that total vaccinations against Covid-19 here have now surpassed 70 million.
What’s more, as of January 22, 2022, 30.78 million Colombians had received complete dosages (in most cases two shots, or else the single-shot Johnson & Johnson vaccine).
In addition, 5.1 million Colombians have now gotten a “reinforcement” dose (in most cases, a third shot), according to Minister Ruiz (see graphic, above).
Meanwhile, Health Ministry epidemiology director Julián Fernández announced January 21 that the Omicron variant continues as the overwhelming type of Covid-19 now found here.
Nationwide, more than 90,000 Colombians are (on average) tested daily for Covid-19, and “peak” Omicron infection rates are now “evident,” Fernández stated.
While hospital intensive-care unit (ICU) capacities are at 100% in some areas as a result of the Omicron surge, there’s still spare ICU capacity in other areas, he said.
Unfortunately, Covid-related deaths have risen over the past week in Antioquia, Medellin, Cali, Valle del Cauca and Bogotá, he said.
The rise in Covid-related deaths “isn’t proportional as in past [Covid-case surges],” he said, as the Omicron variant appears to be less-severe than prior variants – about 40-to-70% less severe.
However, to stem the rising tide of Covid cases, the remaining unvaccinated Colombians should get vaccinated, while vulnerable populations – especially those over 50 years old -- should get the reinforcement shot, he added.
As for children, the Sinovac vaccine appears to be the most effective, with the fewest numbers of side-effects, he added. This is an encouraging sign as more and more Colombian children are returning to in-person classes this year, rather than home-based internet learning.
In total, just 0.05% of vaccinated Colombians have reported adverse side effects from the Covid shots, he said. In contrast, unvaccinated Colombians remain five times more likely to suffer severe illness and death from Covid infections, he added.
Colombia’s Ministry of Health announced November 11 that as of midnight two days ago (November 9), more than 50 million shots of Covid-19 vaccine have now been applied here nationally.
Of that total, more than 22.3 million people have completed their required two-shot (or in the case of Jannsen, one-shot) regimen, while 27 million have received at least one shot.
Meanwhile, the Ministry added that more than 500,000 children here between the ages of three and 11 have been vaccinated against Covid-19 -- more than 7% of the total of this group of children, since this group started getting shots November 1.
While the Ministry noted that such children are in general less vulnerable to the most dangerous effects of Covid-19 – that is, compared to elderly people and other people with co-morbidities – nevertheless 253 children under 18 years old here have died of Covid-19, while more than 400,000 have been sickened by this virus, according to the Ministry.
Meanwhile, Medellin officially reported November 10 that 3.13 million people here have gotten Covid-19 shots, of which 1.46 million have now completed the two-dose regimen while another 1.64 million have gotten at least one shot.
As for all of Antioquia (including metro Medellin), more than 7.1 million shots against Covid-19 have been administered here, with 2.65 million having now completed their two-shot regimen, according to the Antioquia departmental government.
On more positive fronts, millions of doses of Covid-19 vaccines from various manufacturers have arrived or are arriving in Colombia this month, boosting crucial supplies to cities nearly everywhere here.
Among this new flood of supplies: 2.2 million more doses of Biontech/Pfizer vaccines, generously donated by the government of Germany.
As a result, Colombia now has ensured that it has enough vaccines already available here to meet its target of having 70% of its population vaccinated against Covid-19 by year-end 2021, according to the Ministry.
Meanwhile, the Ministry began offering reinforcement doses to populations 70-years and older since October, then added the cohort of those 60-to-69 since November 5.
A popular version of third-dose-reinforcement here involves administering AstraZeneca vaccines to those earlier vaccinated with Sinovac vaccine -- resulting in a statistically valid 97% effectiveness against dangerous levels of Covid-19 infection, according to the Ministry.
Colombia Health Minister Fernando Ruiz revealed October 1 that 40.7 million doses of Covid-19 vaccines have now been applied nationally here through end-September -- meaning more-than-half of all Colombians have already received at least one shot.
Through September 30, Colombia received another 14 air-freight deliveries of Covid-19 vaccines last month, totaling 12.85 million doses.
Meanwhile, for all of 2021, Colombia has so far acquired 83.4 million vaccine doses: 20.3 million through the Covax mechanism; 55.9 million through bilateral mechanisms and 7.1 million through donations -- overwhelmingly from the United States government.
Given Colombia’s total population of 51 million, this means 51.2% have already gotten a first dose and 33% have gotten complete doses against Covid-19, according to the Ministry.
Among population groups, 97% of those over 80 years of age are already vaccinated with one dose and 85.24% have been completely vaccinated, according to Health Ministry promotion director Gerson Bermont.
For the 40-to-49-year-old group, 68.5% have already been vaccinated, while 44% of those aged 20-to-29 years and 37% of those aged 12 to 19 are now vaccinated, he said.
Colombia’s relatively small cohort of people older than 70 years also can get a booster shot starting this month, which would involve Pfizer or Moderna vaccines – even if those people had first gotten Sinovac or AstraZeneca shots earlier this year, he added.
“We have a very important number of vaccines -- 12.8 million doses that have arrived in September, for which there is ample availability to advance the National Vaccination Plan,” added Health Minister Ruiz.
“October is essential to advance and consolidate vaccination. We have to reach 70% coverage of the population by the end of December [2021], for which we have three months to grow and increase coverage,” he cautioned.
As of today (September 6), more than 36.5 million doses of Covid-19 vaccines so far have gone into the arms of Colombians -- and that's likely to hit more than 40 million by September 30, according to latest Health Ministry statistics and forecasts.
What’s more, 15 million Colombians have now been fully vaccinated, along with 21.5 million partly vaccinated-- meaning that Colombia is moving ever-closer to its goal of getting its 35 million most-vulnerable populations protected against Covid-19 by the end of 2021.
Yet ironically, probably 90% of Colombians over the past 18 months have contracted at least one or another version of Covid-19 -- although most had only mild symptoms or unrealized (asymptomatic) effects, according to a new study by Colombia’s Instituto Nacional de Salud (INS, the national health research institute).
Officially, Colombia has recorded more than 4.9 million documented cases of Covid-19, with 125,278 deaths and 4.75 million recoveries, according to latest Health Ministry statistics.
But of Colombia’s total 50 million people, most have never been tested for Covid-19, the INS study showed. Because of that, INS employed a math formula to extrapolate likely infection rates among populations in 12 main cities where Colombians actually did get tested.
According to INS Director Martha Ospina, this math calculation indicates that likely 89% of Colombians have had one or another type of Covid-19 variant in their bodies since testing started here 18 months ago, though most didn't know it.
The “Mu” variant that now predominates in Colombia accounts for 53% of cases currently, she added.
With the more-dangerous Delta variant already here and likely to spread over the next few weeks, that means it’s even more important for Colombians -- and visitors -- to continue wearing masks, avoid crowds, regularly disinfect hands, keep safe distances and get vaccinated (if they still haven’t done that), she said.
In other words, it doesn’t matter if people have already been infected with some earlier, less-dangerous Covid variant. Unvaccinated people that luckily survived an earlier variant can’t be sure of protection against the latest variants -- and what's worse, they can become super-spreaders of Delta variant, sickening and killing many others.
Meanwhile, Health Minister Fernando Ruiz announced September 7 that Colombia now expects to receive 12.75 million doses of Covid-19 vaccines from five pharmaceutical companies during September.
Of those, 2.35 million will come from Pfizer; 1.1 million from AstraZeneca; 4 million from Moderna; 2 million from Janssen; and 3 million from Sinovac.
In total, 76 municipalities in Colombia have already fully vaccinated at least 50% of target populations, helping to stem the spread of infections, slash deaths and cut hospitalization rates. But one-third of the latest vaccination reports have yet to be filed electronically with the Ministry – meaning that the actual vaccination rate is likely higher than the reported rate.
So far, the Ministry has already distributed nearly 40 million vaccinations to hospitals, clinics and health networks in Colombia, including 2.1 million shots being handled by private-sector companies that are vaccinating their employees. That’s likely to rise to 50 million by month’s-end -- and not a moment too soon, given the arrival of Delta variant.
Colombia President Ivan Duque announced July 31 that the nation is on its way to surpass a goal of at least 35 million vaccinations against Covid-19 by end-August 2021 – well ahead of schedule.
Vaccinations are now surging at more than 400,000 persons daily.
With Colombia already having 15.5 million people at least partially vaccinated as of July 31 -- along with 12.2 million now fully vaccinated -- this means Colombia looks on-target to exceed 35 million vaccinations by the end of this month (August).
As of July 31, Colombia had already achieved 27.5 million vaccinations -- 2.5 million more than originally targeted for July. If the nation can achieve an average of about 350,000 shots daily this month, then it will easily surpass the 35-million-shot goal for August.
Meanwhile, Colombia is expanding its vaccination campaign, adding everyone at least 18-years-old, starting this month. That will be followed by a second campaign for those at least 12 years old, starting in late August, according to Health Minister Fernando Ruiz.
The surging vaccination rates spur confidence that Colombia will indeed achieve its goal of getting all 35 million of its most vulnerable populations fully vaccinated against Covid-19 by December 2021.
Meanwhile, Medellin as of July 31 reported having completed 1.89 million total vaccinations, with nearly 900,000 now fully vaccinated – including 717,00 getting the required two-dose regime plus 182,000 more getting the Janssen one-dose shot, according to latest official statistics.
While anti-vaccine conspiracy theorists and some extremist politicians (now even including left-wing demagogue Senator Gustavo Petro) are attacking science-based Covid-19 vaccinations as "useless," President Duque in contrast urges citizens to stay the course.
“Getting vaccinated is everyone’s duty,” Duque stated, adding that the government aims to “quickly reach 30 million,” hence bringing the hoped-for "herd immunity" ever-closer.
