Crisis-hit Colombian public hospital calls for health system reform

By Raquel Godos

Quibdo, Colombia, Jun 21 (EFE).- Employees at the Ismael Roldan Hospital in this northwestern Colombian city have not received their salaries for nine months, but if they were to stop working patients across the entire department of Choco would have virtually nowhere to go for medical care.

With the city’s other public hospital having been taken over by the state due to mismanagement, the unsustainable situation is evident in jam-packed waiting rooms and a lack of doctors, nurses and stretchers to attend to all of the patients.

Amid the grim reality, the hope now is that a proposed health care reform being promoted by leftist President Gustavo Petro’s administration can resolve the crisis.

Ismael Roldan, a primary-care hospital that does not perform surgeries or provide specialist care, unlike Quibdo’s other public hospital, San Francisco de Asis, attends to a potential urban population in Quibdo of around 66,000 inhabitants.

However, patients also arrive from other parts of Choco, whose population exceeds 500,000 inhabitants.

With just 50 beds spread across its emergency room, adult wing and pediatric and maternity wards, that public hospital is far from able to attend to the needs of all patients in its coverage area.

Even so, “all of the other institutions, most of them private, steer their patients to the public hospitals, even though they know we’re not prepared to attend to certain levels of complexity,” Tulio Ramos, the head of the hospital’s emergency room, told Efe.

Patients with complex pathologies can only receive the specialized care they need in a hospital 230 kilometers (140 miles) away in Medellin, although they often must endure treatment delays because the road to Colombia’s second city is frequently closed due to landslides.

Colombia’s current health-care system is complex and depends on dozens of health promoting entities (EPSs) – most of them private, but also public or mixed health insurance companies – that are responsible for organizing and guaranteeing access to medical services.

Those EPSs affiliate the population and contract with a network of health service entities (IPSs), the hospitals, clinics, laboratories and health professionals who deliver medical care directly to patients, using their leverage to keep costs down.

In some cases, the IPSs have accused the EPSs – who receive money from the government, as well as workers’ and employers’ mandatory contributions – of failing to reimburse them for the cost of care and leaving them mired in debt even as they are still forced to provide basic treatment to patients.

The health reform promoted by Petro, a controversial measure currently stalled in Congress amid political scandals and a loss of support from allied parties, aims to slash the EPSs’ role as intermediaries and provide funds directly from the state to the IPSs.

“The financial situation of the (Ismael Roldan Hospital) is quite critical. Our monthly expenses are greater than our level of income,” said Sandra Casas, assistant manager of that medical facility.

At present, the hospital has a debt of 15 billion pesos ($3.5 million), 50 percent of which corresponds to back pay owed to its staff.

“All salaried employees need to be paid in a punctual manner, but we all understand that the situation of the current health model has, in one way or another, affected the financial situation of all the hospitals in Colombia,” Casas said.

She said she is optimistic about Petro’s health reform because it will mean that hospitals like Ismael Roldan will no longer depend on third parties and instead receive money directly from the state.

“I believe in the health reform. If the money gets directly to the hospitals without intermediaries and the hospitals become hospitals, and not state enterprises, I think we can get out of this situation. The reform can especially have an impact on public hospitals,” Casas added. EFE


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