Eliminating Savia would collapse Antioch’s health system

Savia Salud, the second EPS with the largest number of branches in Antioquia, has been on the ledge for five years since it entered Supersalud special monitoring due to its financial crisis.

Last June, after much pushing and pulling among its partners, it was able to put together a $120,000 million capitalization plan that they believed would be able to weather the crisis. Today, however, they fear that news of the liquidation will arrive in the coming days.

The fear arose after the liquidation last week of Convida, a public EPS belonging to the government of Cundinamarca, because it did not meet any of the three basic requirements: minimum capital solvency, adequate equity capital and investment regime.

The risk of suffering the same fate, added to the uncertainty created by Petro’s government announcements and reform proposals, caused alarm in Savia.

It was Health Minister Carolina Corcio who came out yesterday – with numbers and lengthy explanations – on comments that hinted at her ministry’s alleged interest in undermining the current system to undertake reforms.

Korcho specified that, contrary to what some sectors said about the alleged underfunding of health care, the two proposals of the government increase the funds for providing and for the attention of families of the subsidized regime.

But what she and the chief of health, Ulahi Beltrán López, have ratified is the critical state of the EPS and their belief that they are honest with the technical, scientific, financial and legal requirements of these entities.

Beltrán showed the situation of 10 EPS under special watch, which add more than $4.7 billion in accounts payable. Among them is Savia with 1,666,262 affiliates and over $653,000 million in liabilities. According to Super Savia, it does not meet the three requirements: no minimum capital, adequate equity or investment regime.

What Beltran said is that these entities will have to demonstrate important changes in their operations or else they will have to be liquidated.

And exactly what Savia wants to show, according to its manager Lina Bustamante, is that they are heading towards these changes. The problem is that so far neither super nor the ministry have heard them.

The risk of the domino effect

Bustamante emphasizes that since June they have presented the plan for the capitalization and reorganization of the enterprise to Super.

Savia has a capital deficit of minus $560,000 million. As part of the capitalization, the governor’s office pledged to put in $40,000 million; Comfama, $4,000 million; hospitals $40,000 million, with the remainder matched by private providers. This is the first phase to capitalize on 50% of that equity shortfall and come out on top. Super was supposed to give its approval, but with the change of government, the process was delayed.

Bustamante points out that in addition to a viable financial proposition, Savia also has results to show in health care that are compatible with the model proposed by the Petro government, as an articulation with providers to reach the inhabitants of dispersed rural areas and routes for care and prevention together with state hospitals.

However, the manager states that it is a mistake to point all the sources of the current model’s problems to the EPS. What this explains is that if a detailed review of the status of many ESUs in the subsidized system, which do not meet the health indicators or are under special surveillance, it will be found that they are dependent on the response of public providers.

“We sat down with Aesa and put on the table issues that concern us very much: maternal mortality, control of patients with hypertension and diabetes. We are highly dependent on the public network. There are issues where they have taken responsibility and others that are the responsibility of the community,” he says.

There is one case that illustrates Bustamante’s position. A mother in a municipality, who came for the first check-up at 34 weeks of pregnancy. She was not connected to the system; they connected her to Saviya, managed to cure her, but later she died due to complications that should have been noticed early in the pregnancy.

What the manager intends to point out is that the capacity of health secretariats and public hospitals interferes with the performance of health indicators, so it is inaccurate to hold EPS alone accountable and it is counterproductive to liquidate those who, like Savia, are trying to add to departmental systems.

Savia’s special surveillance measure expires next Tuesday, September 27. If Super decides to liquidate it, it will unleash, according to Bustamante, a chain effect, since 72% of the network in Antioquia is public and many hospitals such as General, University IPS, departmental and municipal are “juice-dependent.”

Patient migration would be another problem. According to Bustamante’s estimates, Sura will be the EPS where at least half of Savia’s users will land, which could exceed its capacity and also force it to capitalize close to $64,000 million.

Concerned about the effects it would have on the department, Governor Anibal Gaviria requested a seat with Minister Corcho. Lina Bustamante says that she hopes to be able to meet with the chief, something that they have been looking for persistently and have not achieved, to find an outlet that really helps.