“The Government Has Made Fools Of Us:” Tensions Rising Between Colombian Doctors & Government

Colombian doctors are threatening mass resignations in the middle of the Coronavirus COVID-19 Pandemic, because they are not being provided with personal safety equipment, are being threatened for speaking publicly about their predicament, and in many cases, being owed several months back wages by hospitals & IPS (Independent Health Providers, or clinics).

“No one can force us to commit suicide.”—Dr. Sergio Isaza

These charges are made by Dr. Sergio Isaza, head of the Colombian Medical Federation, the group representing the interests of Colombian doctors in the country. The doctors oppose Article 9 of Decree 538 of 2020 issued by the Colombian presidency, that seeks to obligate doctors to attend to the Coronavirus COVID-19 Pandemic irrespective of circumstances.

Dr. Sergio Isaza, head of the Colombian Medical Federation (Photo courtesy of the Colombian Medical Federation)

“We are not obligated by a decree, but by the oath we took when we graduated; not under any threat of sanction so the minister must remove that article,” said Dr. Isaza to W Radio in Colombia. Representatives of the federation, accompanied by the Colombian Association of Scientific Societies, The Colombian Medical College, and the Federation of Medical Unions walked out of negotiations with the government when they refused to amend Article 9. That led to a breakdown in relations between the four groups and the newly appointed health minister, Dr. Fernando Ruíz (above right).

21 doctors in Cartagena have already resigned from hospital Clinica San José de Torices. The doctors claim that they have repeatedly and formally asked for basic protective equipment but were ignored

“Doctors must be equipped according to the complexity of the patients they serve: gloves, gowns, masks, hospital clothes; guaranteeing the dressing rooms and that the staff should not go out with the same clothes that they use in the clinic for their home,” said Dr. Isaza. “It is not just that they give us gloves, masks, robes and dresses, because it is something to be expected. That is why the National Government must sanction the EPS (health plan providers) and IPS (clinics and hospitals), and punish those who fail to comply. This must be monitored by the National Health Superintendence, which has done nothing, in addition to the Office of the Attorney General and the Comptroller,“

Endemic Corruption

Colombia has a mixed public/private health care system that ranges from world-class to 3^rd-world depending upon geography, funding model and management. Hospitals may be public (government owned) or private. Along with specialty clinics, larger doctor’s offices and urgent care facilities, these are classified as IPS (Independent Health Provider) and may charge patients directly or receive payment by the various EPS (Health Provider Entity) programs. EPS are similar to health insurance plans or cooperatives and are generally paid for by employers or the government. In the case of independent  workers, they are paid directly by the policyholder. Low income residents have their EPS premiums subsidized or paid for by the government. Some EPSs are well run, others are mismanaged, then others still are flat out corrupt. Hospitals complain that EPS plans generally run several months behind in payments. Employees, rather than employers choose their EPS, then the employers contribute a fixed amount to the EPS coverage, irrespective of which the employee chooses.

Two Colombian doctors, Dr. Carlos Nieto and William Gutiérrez have already died due to the COVID-19 virus.

Optionally, Colombians and foreigners alike may purchase “medicina prepagada,” or private health insurance that works “on top” of EPS plans. These deluxe plans provide an additional level of care with separate facilities and doctors, and benefits such as doctor’s house calls, sports medicine, and coverage abroad for traveling policyholders.  Some companies, like SURA operate EPS plans, private insurance, and their own hospitals and clinics.

Doctors, clinics and hospitals may also charge patients “cash” directly, and some choose to completely opt out of government or private insurance arrangements.

On the other hand, many hospitals are government run and EPS plans serving low income patients are built around payments from SYSBEN, Colombia’s welfare plan (similar to Medicaid in the US). This creates tremendous opportunities for corruption. The Colombian government is already embroiled in “Coronavirus Corruption” with the government depositing COVID-19 Pandemic relief funds into thousands of ghost accounts, and procurement irregularities.

Many government hospitals have begun construction over the years but were never finished, with politicians and contractors bagging the funds allocated by local, departmental and the national government agencies.

The new mayor, William Dau, who ran on an anti-corruption platform in the historically corrupt coastal city of Cartagena let loose an expletive-laced tirade that put entrenched members of city-council such as Cesar Pión on the defensive. The citizens of Cartagena broke out in a spontaneous “cacerolazo” in support of their new mayor after his emotional diatribe. A “cacerolazo” is a type of protest in Latin America where people noisily bang on pots and pans outside of their windows.

A esto nos ha llevado la Clase política de Cartagena.
Se robaron toda la red hospitalaria, sumieron a la ciudad en pobreza, estancamiento, desigualdad.

No me preocupan la expresiónes del Alcalde, me preocupa mas ciudad.

Apoyó a @daulaw pic.twitter.com/TBG4V4vIpn

— Wilman De Los Reyes Franco (@Wilman_1998) April 13, 2020

Mayor Dau (pictured in above tweet) pointed out  more than a dozen unfinished hospitals in Cartagena; monuments to the city’s corruption and the avarice of its traditional political families.

On the defensive, Colombian Government Responds

Friday, the presidency announced that it was going to allocate $175 million USD immediately to purchase the receivables of hospitals, medical practices and IPS that are owed money by EPS plans. This is in addition to the $91 million already allocated to the EPS system, money that may or may not matriculate through to hospitals, IPS and doctors.

“Today I signed Resolution 619, which opens the portfolio purchase in ADRES (Administrator of the Resources of the General System of Social Security in Health) for $ 700,000 million COP,” said Minister of Health Fernando Ruiz (top photo, right), who stressed that the purchase is direct and not through the financial system.

“Right now we are working very intensively so that, from June and hopefully from before, from May, we can start turning over all of these resources, the $ 5.2 billion we have there and that would give immediate liquidity to the system,” said the minister.

Colombia’s president Ivan Duque (top photo, left) has announced that this week the government will disclose health measures that will remain in place when the 24-hour national pandemic is expected to be lifted on April 27^th.