With more than five million affiliates, the insurer argued that the health system faces historic underfunding and "it is a problem that surpasses us as a company."
This Tuesday, May 28, Colombia's health system was shaken yet again. Sura EPS, one of the largest health insurers in the country, announced that it has asked the Health Superintendency permission to gradually exit the health system. The regulator has 65 business days to make a decision on the request.
EPS Sura currently has 5.54 million affiliates, the majority in the contributory (non-subsidized) regime (4.6 million). “We have looked for ways to maintain a role in the system. We have spoken with (sector) players. However, time has run out and measures must be taken to prevent further deterioration,” said Juana Francisca Llano, president of Suramericana (Sura's holding.) “The health system faces historic underfunding. It is a problem that surpasses us as a company.”
“We have done everything possible to continue providing services, including analyzing the reforms proposed by the government. We were willing to assume the role of managers, but not in just any way. This is why we sat down to talk. However, the reforms known thus far do not resolve the structural problems of the system,” Llano said at a press conference this Tuesday.
In simple words, the gradual dismantling program is a legal figure that allows the orderly and diligent withdrawal from the health system. Sura's request consists of carrying out an organized and planned transition of its affiliates, guaranteeing the complete delivery of clinical information and supporting the continuity of treatment, according to the people's health needs.
However, Llano was emphatic in clarifying that they will carry out a “coordinated transition that favors continuity of treatments and we will continue taking care of patients. The procedures and care will continue to be provided as usual. And the service channels will remain active.”
As Ana María Vesga, head of Acemi, the association that brings together the EPS (of the contributory regime), says, Sura's measure was expected. “Despite being an efficient and well-managed EPS (insurer), it has not managed to correct what has been happening after the COVID-19 pandemic, in terms of spending and financial imbalance,” says Vesga.
EPS Sura was, in fact, one of the first to approach the government and express its intention to become a manager, as proposed by the administration's health reform plans.
However, as Vesga explains, for that to happen a new law was required, but in the end the health bill was not approved and Sura was already in trouble. It did not meet, she adds, hey minimum equity indicators, except for technical reserves. “With an insufficient UPC (what the government pays the EPS for each affiliate), the situation was unsustainable,” she says. In addition, she reiterates, the government owes them money.
“For that reason, we had made that decision, which was unpopular, to approach the government and evaluate the management model. It was a way to preserve some of the features and keep users. But today, there is no reform, there is no resolution from the Ministry of Health and, then, this situation was foreseeable.”
“There is sadness in the sector, because it was one of those EPS that was characterized by taking care of its users, that is always attentive to them, that was always impeccable in its payments,” says a senior executive in the sector.
When will EPS Sura leave the health system?
For the moment, Sura presented its proposal to the Health Superintendency (Supersalud), which will have a period of 65 business days to study it and decide whether to accept it or not, explained Pablo Otero, manager of EPS Sura.
After that period, if Supersalud approves so, both government and Sura will agree on what this gradual dismantling will be like and begin the execution plan.
However, Llano said that the doors are not closed to a different proposal that comes from Supersalud and stressed that they will continue to provide health services.
EPS Sura figures
EPS Sura indicated that its casualty rate compared to the UPC was 102%. This is, they spent 102 pesos from every 100 received from the government to guarantee its affiliates' health services. Among the reasons to explain the disparity, Sura pointed out to the insufficient annual increases in the UPC.
According to Sura, as of December 31, 2023 it was one of the few insurers that complied with the Technical Reserves Investment Indicator, which has been one of the parameters of non-compliance that the government has used to intervene other insurers, such as EPS Sanitas. Sura, according to its indicators, has consistently complied with the indicator since 2021.
In further detail, Sura said that it complied 104% with the technical reserves as of January 2024. In 2021-22, the insurer also complied with other financial quality indicators, such as adequate equity and technical equity, although it stopped comply with them by September 2023. In the communication that Sura sent to the Congress at the time, the insurer pointed out that this non-compliance was “the result of the accumulated losses that have consumed the company's assets and whose situation has been exposed in different spaces and communications. to the Ministry of Health.”
In fact, Sura said that its assets declined, going from 391.7 billion pesos (approximately US$ 101 million) in December 2021, to $4.2 billion (just over US$ 1 million) in December 2023.
