Analysis of the healthcare proposal of presidential candidate Iván Duque

Iván Duque has named Fabio Aristizábal as his Healthcare Advisor for the campaign.  Aristizábal has more than 20 years’ experience in the healthcare system, advised former President Álvaro Uribe Vélez and took part in the writing of Proposed Law 090 to reform certain aspects of the healthcare system. He has also been District Secretary for Health in Antioquia. In spite of his distinguished career, the make-up of the Candidate’s healthcare team and scope of his proposals are not entirely clear, generating some degree of uncertainty in the sector.

According to AGORA’s analysis, it can be affirmed that the Candidate has a high degree of interest in the healthcare sector. He has made two political speeches on healthcare during the campaign. As a senator, he prepared ten law proposals, two of which were passed. He has also worked as an academic, during which he had contact with unions such as ANDI, established ties with governmental entities such as the Ministry of Health and the National Superintendent of Healthcare and made regular media appearances on issues related to healthcare.

The Candidate’s program is called ‘Healthcare Equity to Generate Social Cohesion: Quality Healthcare Above All’ and contains the following components:

  1. The healthcare system will focus on the structural prevention of transmittable and non-transmittable diseases and will act to reduce the dangerous increase of cardiovascular and respiratory diseases across the country.
  2. An agenda of good healthcare habits has been prepared to prevent obesity and excess weight across the population, mainly in children and adolescents. The focus in this regard will be multi-dimensional and aimed at educating consumers and identifying preventative mechanisms to benefit the population.
  3. The entire healthcare system (EPS, IPS and governmental agencies) will be aligned, coordinated and evaluated through the use of Big Data. Abuse will be identified early and solutions will be proposed in accordance with real-time observations.
  4. Clinical histories will be one hundred percent digital and made available to healthcare professionals.
  5. Hospital administration shall be in the hands of serious professionals chosen on merit. They will be regularly evaluated.
  6. Vertical integration will be checked extremely closely to prevent and punish abuse. Remuneration systems for the EPS will be established so that they aren’t solely dependent on the size of their membership.
  7. The sustainability of the system depends on all its different actors. Formalizing work means contributing to the healthcare system in a more transparent way so that only the most vulnerable will depend on subsidies.
  8. EPS will have to reduce debts to service providers (IPS) greater than 90 days. From now on, delayed payments without justification will enter into the late payment category and fall under the jurisdiction of the Superintendent of Health.
  9. Digital comparison systems will be the basis for the evaluation of fair prices for medications in real time with transparency and automatic corrections in favor of the user.


AGORA’s conclusions and issues not addressed by the Candidate’s program

In summary, the Candidate’s program is based on the current insurance model and the structured pluralism framework. The focus is on strengthening healthcare information systems as a tool for the improvement of monitoring systems and thus to improve the flow of finance and especially the liquidity of the system through the reduction of the portfolio of debt greater than 90 days. However, significant questions remain about i) the proposal to resolve the structural problems of financial sustainability throughout the healthcare system, ii) the implementation of the public agenda regarding awareness and prevention that each candidate has announced, and iii) pharmaceutical policy and instruments to control costs. The following conclusions can thus be drawn:

  1. The government’s program as announced during the campaign does not address the structural issue of current and future financing of the Colombian healthcare system, i.e.: the payment of the accumulated debt of 8 billion pesos and the resolution of the issue of public spending on health exceeding current sources of financing. Although it’s true that mention has been made of improving macro-economic conditions and formalizing work throughout the country, thus increasing contributions to the system, issues with the formula and basis of the current system are challenges that Colombia has not been able to deal with in the past two decades.
  2. The program still has to identify the mechanisms that will make its public healthcare goals possible, especially the alignment of incentives to achieve it. Although the Candidate has made statements in speeches and public debates about his intention to develop a system to recognize performance, this is not reflected in his formal proposal for government.
  3. The program only offers timid proposals to control spending through price-fixing of medications using a comparison system. However, there are still doubts about whether the current mechanisms the government has developed will be continued or extended to control the price of healthcare technologies, these being the strongest and most stable policies of the administration of Minister Alejandro Gaviria.
  4. In essence, Candidate Duque’s proposal takes a macro-economic approach to the healthcare system but lacks a detailed vision for healthcare, leaving key issues with the SGSSS unresolved.