Health & Insurance. 56
Colombia’s Health Minister Fernando Ruiz Gómez announced April 16 that the current national quarantine against Coronavirus infections will continue past the presumptive April 27 deadline expiration.
However, many current restrictions gradually will be relaxed -- but only when accompanied by strict health protocols, he revealed.
As of April 16, Colombia had reported 3,233 Coronavirus cases nationally, of which 1,333 were in Bogota, 559 in Cali/Valle del Cauca and 308 in Medellin/Antioquia. So far, 144 deaths are reported from Coronavirus complications nationally, with 550 persons fully recovered to date, according to the Health Ministry.
Unlike the U.S., Europe, parts of Asia and elsewhere, Colombia has to date generally avoided a disastrous spread of Covid-19 -- thanks to a general quarantine that started March 20, the Minister noted.
“Colombia opted for a quarantine model in which we have part of the economy functioning: public services, agriculture, food, transportation, medical services and home deliveries, the parts of the economy that support the basics,” he said. “But a society cannot be kept permanently closed,” he added.
In contrast to the current situation in Colombia, countries such as the U.S., Italy and Spain unwisely maintained relatively “open economies” even as Coronavirus cases multiplied. But soon afterward, most of these previously uncautious governments “had to abruptly close down due to the impact of the epidemic curve,” he noted.
In contrast, Colombia took quarantine measures broadly and more promptly, while still maintaining essential services -- avoiding catastrophe, yet still maintaining crucial food, medicine, banking, transport, agriculture and public service sectors, he noted.
Now, “we are looking for strategies to open the economy together with [partial quarantine] isolation -- and how to establish this gradualness, because a closed economy throughout the year will generate severe problems with unemployment, poverty, hunger and all the implications for people’s health,” Ruiz added.
“What we are proposing from the Ministry is not the termination of the quarantine on April 27. That is not the strategy.
“The strategy is to maintain mandatory preventive isolation for specific groups and mandatory preventive quarantine of the entire population with the option of a very systematic, gradual and controlled global opening of some sectors of the economy -- but with the clarity that any eventuality or risk that could be generated will trigger a return to [a stricter] closure, as foreseen in the models that the INS [National Institute of Health] has developed,” he explained.
To enable gradual reopenings of more economic sectors, “new guidelines will have to be created, which, according to Decree 539, are made in a unified way by the Ministry of Health, because what we are looking for is that there be comprehensive protocols for all Colombians,” he concluded.
However, “we have areas in the country that are ahead [of the statistical infection-rate curve], others that are behind in number of cases and curve, but also rural areas where it is much less -- and that is because they live at a much greater distance [from cities], which makes the probability of contagion less,” he added.
50% Infection Rate Statistically Possible, Triggering Greater ICU Capacity Building
Meanwhile, the Health Ministry continues to run computerized statistical-probability scenarios tied to contingency plans for treating a potentially broader Covid-19 epidemic, the Minister explained.
“In order to establish the parameters for the needs at the territorial level, we took a [theoretical] indicator that showed that slightly more than 50% of the Colombian population is susceptible,” he said.
“The population that becomes infected in the first wave [under this statistical model] is lower because the proportion of our population that is younger is greater than in countries like China, Italy and France. Another factor that is analyzed is that we have a smoking rate – just 14% -- lower than other countries,” he said.
“The updated projection in our country is that 12% of those affected will be asymptomatic and 88% symptomatic. From the latter group, it is necessary to determine whether we’re dealing with [relatively greater numbers of] patients with mild symptoms -- requiring outpatient treatment -- or severe or critical patients – requiring hospitalization -- and thus determine the beds required in intermediate and intensive care.”
Because Coronavirus patients in “critical” state would require intensive care unit (ICU) segregation, the Ministry calculated potential expansion of ICU capacity in Colombia.
“Due to the structure of our health system, where the payment of services is made by event, the majority of providers in our country have had a very great incentive to take patients to intensive care. This led us to have more units of intensive care per capita than many countries,” Ruiz explained.
To address a broader epidemic, “we are not inventing new hospitals [but rather] an expansion of the [existing] network with provision of logistics, medical histories, systems and everything else necessary,” he concluded.
Notably, major cities including Medellin, Bogota, Cali and elsewhere are already moving quickly to increase ICU capacity for an expected increase in future “critical” Coronavirus cases. Medellin leads all Colombia in commercial production of specialized Coronavirus ventilator machines, due for start-up April 20.
Medellin Mayor Daniel Quintero announced April 15 that local home-appliance manufacturing giant Haceb and local motorcycle assembler Auteco will launch manufacture and assembly of novel Coronavirus ventilator machines -- starting Monday, April 20.
Three prototypes have been developed in Medellin via a research and technology consortium organized by tech incubator Ruta N and Colombia’s national industrial-commercial trade association ANDI.
Coronavirus ventilators on the global market have been quoted as costing more than COP$150 million (US$38,000), the Mayor noted. But the locally produced ventilators are expected to cost a small fraction of that -- perhaps in the range of US$1,000 to US$2,000.
“The three prototypes, which are part of the '#InnspiraMED' project, were independently developed by Sampedro Medical Industries, the University of Antioquia and the EIA University, meeting all Invima [Colombia medical products regulator] quality and safety standards,” according to the Mayor’s office.
“This is going to allow us to save lives -- not just for Medellín and Antioquia, but for all of Colombia,” Quintero added.
In his April 15 announcement, the Mayor didn't specify exactly how many ventilators will be produced initially, the total expected forecast production, retail prices and commercial availability dates.
Three prototypes of mechanical ventilators being developed for Coronavirus victims by metro-Medellin-based Sampedro Medical Industries, the University of Antioquia and the EIA University are now set to move to human trials following successful tests at CES University School of Veterinary Medicine and Animal Husbandry here.
The development teams are now preparing for tests on human beings and, subsequently, the start of production at two Medellin-metro manufacturing giants: multinational home-appliance manufacturing giant Haceb and motorcycle assembling giant Auteco.
“Advances like the one taking place today are possible thanks to [Medellin-born multinational bottled drinks maker] Postobón’s donation in the project,” according to an April 10 announcement from Medellin-based tech incubator Ruta N, organizer of the “#InnspiraMED” ventilator consortium.
“The three mechanical ventilators for intensive care units (ICUs) [for #InnspiraMED] successfully carried out preclinical tests in the operating rooms of the Faculty of Veterinary Medicine and Zootechnics of CES University,” according to Ruta N.
“The three devices, which are a success thanks to the donation of Postobón and hundreds of people who have joined this initiative through the #InnovaPorLaVida and # UnidosSomosPaís platforms, have been developed in compliance with Invima [Colombia’s national medical-standards regulator] quality and safety standards. The articulation work between all the actors has been led by Ruta N and ANDI [Colombia’s national industrial-commercial trade association].
“One of the prerequisites for achieving success in preclinical trials was the development of in-vitro [laboratory-scale] tests by the group of anesthesia and critical care specialists at the San Vicente Fundación University Hospital, the Las Américas Clinic and the Pablo Tobón Uribe Hospital. These tests consisted of subjecting the ventilators to different clinical conditions with highly specialized simulators that evaluate their operation and, thus, be able to determine how safe they are for patients.
“With the results of the preclinical tests, preparations will be made to proceed with tests on humans, which will allow the devices to be definitively validated and go to the production phase that will be headed by Haceb and Auteco,” Ruta N added.
The three prototypes were designed for rapid scale-up for production, according to the consortium.
FLA Delivering Antiseptic Alcohol to Stores
Meanwhile, the Antioquia departmental government announced April 8 that starting today (April 11) its government-owned Fabrica de Licores de Antioquia (FLA) will start delivering bottles of antiseptic alcohol (70% pure alcohol) to local supermarkets.
“The product’s profit margins will be minimal for each of the actors in the distribution chain,” according to the FLA.
The FLA earlier produced 250,000 bottles of the alcohol to disaster-response agency DAPARD and subsequently to hospitals, clinics and public-safety agencies, according to the company.
“The main objective is to ensure that the greatest number of people access a product that becomes vital when taking aseptic measures and that contributes, to a large extent, to [Coronavirus] contingency control,” according to the FLA.
Colombia’s Health Ministry announced March 30 that it’s accelerating national payments totaling COP$2.1 trillion (US$517 million) to hospitals and clinics this year in order to respond to an expected surge of Coronavirus patients.
The accelerated payments total a little less than half of the COP$4.5 trillion (US$1.1 billion) in subsidies budgeted for the entire year of 2020, according to the Ministry.
Meanwhile, as of March 30, the Health Ministry had reported 798 Coronavirus cases nationally, led by Bogota (350) and Cali/Valle del Cauca (104). Antioquia ranks third with 96 cases, of which 60 are reported within the city of Medellin.
Among the Antioquia cases, most involve people that had traveled to Spain, the USA, Jamaica, Turkey, Brazil, Italy, Panama, the UK, Ecuador and Germany, according to the Antioquia Departmental government. The remaining cases involved people who were cross-infected by foreign travelers.
So far, 12 people have died nationally from Coronavirus complications – none in Antioquia -- while 15 patients have fully recovered, according to the Ministry. The vast majority of victims are recuperating at homes rather than in hospitals.
“In order to guarantee financial liquidity in the nation’s hospitals and clinics in the face of the Coronavirus health emergency, the national government made the decision to anticipate the transfer of COP$2.1 trillion (US$517 million) corresponding to budgeted resources for the sector for the entire year, which will be disbursed to the institutions that provide health services [that is, Institutos Prestadores de Servicios de Salud, ‘IPS’] during the month of April and the beginning of May,” according to the Ministry.
Colombia’s Administrator of Resources of the General Social Security System in Health (ADRES) has already ordered advance payment of COP$782 billion (US$192 million) to health provider and insurance networks to help pay for certain other high-cost procedures and drugs that fall outside mandatory covered services in the “EPS” (empresas promotores de salud) insurance network schemes, the Ministry added.
Now, an additional COP$540 billion (US$133 million) will be released to health networks between April and May for mandatory covered services (including Coronavirus cases).
Yet another COP$700 billion (US$172 million) will be paid in May “so that hospitals, clinics and other medical centers can access the hospital portfolio purchase mechanism” in anticipation of future ADRES payments, according to the Ministry.
Colombia’s National Institute of Health (“INS” in Spanish initials) announced March 29 that it's about to receive high-tech Coronavirus laboratory-analysis equipment donated by the International Atomic Energy Agency (IAEA).
“The donated equipment, reagents and biosafety elements, which will arrive in the country in the coming days, will allow the National Institute of Health (INS) to continue applying the ‘RT-PCR’ technique, which manages to determine with 99% effectiveness who has acquired -- or not acquired -- the virus,” according to INS.
“In addition, this will improve the installed capacity of the INS to carry out new analyses of the disease in the national territory with the application of nearly 2,000 tests.
“Further, this will allow continuing the training process for scientists from higher education institutions, which have been preparing to implement the detection [analysis] techniques.”
An older diagnostic machine at INS suffered damage several days ago, but the Roche pharmaceutical company stepped-in to repair it on March 27, according to INS.
Meanwhile, as of March 28, Colombia had confirmed 608 cases of Coronavirus nationally, with Antioquia accounting for 67 cases. Six people have died nationally, but none so far in Antioquia.
EPM Donates Ventilators, ICU Capacity
On a related front, Medellin-based utilities giant EPM announced March 28 that it donated COP$3 billion (US$748,000 ) to boost Intensive Care Unit (ICU) capacity at University IPS Hospital (Leon XIII Clinic) in Medellin – specifically for coronavirus (COVID-19) victims.
“The monies will be used to buy 42 new beds to attend to potential patients in complex conditions, due to the coronavirus (COVID-19). In addition, 37 ventilators will also be purchased, essential to treat patients when vital signs deteriorate and their lives are put at risk,” according to EPM.
Besides the ventilator purchases, the donation includes another 24 vital-signs monitors, three defibrillators, two 12-channel electrocardiographs and a central monitoring unit, according to EPM.
IPS Buys Another 1,510 Ventilators
Meanwhile, the Colombian Health Ministry announced that it just signed a contract for 1,510 ventilators for the expected surge of Coronavirus victims nationally. However, the Ministry added that this initial purchase likely won’t be sufficient, with at least 7,500 ventilators expected to be required nationally.
Medellin Refurbishes ‘Saludcoop’ Clinic
Meanwhile, on March 28, the Medellin Mayor’s Office announced that it’s refurbishing and reopening portions of the former “Saludcoop” clinic on Avenida 80, including installation of 156 ICUs “to serve all Covid-19 patients who require it.” Employer-benefits organization Comfama, paint manufacturing giant Pintuco and IPS Universitaria Hospital all contributed to the refurbishment.
“To date there are already 67 [Covid-19] cases reported in Antioquia, and 43 of these people reside in Medellín,” according to the Mayor’s Office.
Five new cases in Medellin were reported last week -- all of which involved persons returning from foreign travel -- and three other persons here have had full recoveries so far, according to the Office.
“The population between 20 and 29 [years of age] continues to be the most affected, for which reason young people are called to comply with the obligatory social distancing,” according to the Mayor.
“Regarding the successful recovery of three people, Rita Almanza, an epidemiologist at the Ministry of Health, stated that these are cases that ‘at the beginning of the epidemic were diagnosed, and then after quarantine, they had a second negative test result.’”
Health Ministry Sends More Money to Antioquia
On another front, Colombia’s Health Ministry announced March 28 that it just sent COP$84 billion (US$21 million) to Antioquia to cover past-due debts at hospitals, clinics and government-subsidized “EPS” (empresas promotoras de salud) health-insurance networks.
“This sum will allow the department to settle the overdue debt for services and procedures not financed from the capitation payment unit (UPC) in the subsidized [EPS] regime and, according to the provisions of Resolution 916 of 2020, Antioquia will proceed to make the payment to the corresponding beneficiaries and creditors” including hospitals, clinics and suppliers, according to the Ministry.
The extra monies also would help hospitals and clinics deal with an expected surge of Coranvirus victims -- among which will be patients in the government-subsidized sector.
A new study by Colombia’s health ministry (Ministerio de Salud) found that Suramericana EPS, Sanitas EPS and Aliansalud EPS were rated the top-three health insurance network providers by patients in the “contributory” (user-pays, employer-pays) “Entidades Prestadoras de Salud” (EPS) health-coverage sector.
However, the study didn’t cover health-care consumers in the prepaid sector – an attractive insurance alternative for many wealthier expats (and richer Colombians).
Several companies including Suramericana and Coomeva offer prepaid health insurance coverage in Colombia. However, these policies are much more expensive than EPS policies -- and they’re beyond the budget of most Colombians.
In addition, only Coomeva offers prepaid health insurance to people 60 years and older, which puts most older expats (and native Colombians) either at the mercy of relatively slow EPS coverage for certain expensive and optional procedures, and for certain drugs -- or else paying cash/credit for faster, broader services and broader drug options.
Still, people in the prepaid insurance system also must buy a complimentary EPS policy -- which effectively helps subsidize the cost of coverage for millions of others stuck in EPS networks.
As for the “subsidized” EPS sector (mainly for indigents), the top three EPS networks in the Ministry study were Associação Mutual Ser Empresa ESS; Caja de Compensacion Familiar de la Guajira; and Asociacion Mutual Barrios Unidos de Quibdo, according to the ministry report .
In all, the top 13 EPS networks in the contributive sector were (in order):
1. Suramericana EPS
2. Sanitas EPS
3. Aliansalud EPS
4. Nueva EPS
5. Compensar EPS
6. Salud Total EPS
7. EPS Famisanar
8. Saludvida EPS
9. Coomeva EPS
10. Servicio Occidental de Salud EPS
11. Comfenalco Valle EPS
12. Cruz Blanca EPS
13. Cafesalud EPS
The top 10 EPS’s in the subsidized sector were:
1. Asociacion Mutual Ser
2. CCF de la Guajira
3. Ambuq ARS
4. Coosalud EPS
5. Comfacor
6. Comfaoriente
7. Comfasucre
8. CCF Cajacopi Atlantico
9. Emdisalud ESS
10. Ecoopsos ESS
For the study, health-services consumers were asked to rate companies by 51 indicators, with 24 indicators relating to the opportunity to receive certain services, 19 relating to relative satisfaction with services, and eight relating to the ease-of-access to services.
However, a relatively high ranking as indicated in the Ministry study doesn’t mean that all patients are happy with health services. On the contrary: Many of the more-complex, more-expensive health services and certain high-cost drugs aren’t readily available in EPS networks, or at least not very timely.
What’s worse, hospitals and clinics that provide such EPS services too often face enormous delays in reimbursement -- with past-due bills running into the billions of dollars (see Medellin Herald stories in the “hospitals, health and insurance” subcategory under the “Antioquia” main category).
As a result, various hospitals and clinics around Colombia have at times been forced to delay paying wages to hospital workers and vendors – in certain cases, for months at a time. Some hospitals have been shuttered permanently.
What’s more, several national EPS networks have gone bankrupt or have drastically reduced services in many areas, as income simply hasn’t been anywhere near enough to cover expenses -- or (in certain cases) mismanagement and corruption have destroyed the business.
Editor's Note: The following article -- originally authored in Spanish by Colombia Ministry of Health economist Jhon Gonzalez Lindarte -- is reprinted by special permission granted to Medellin Herald by El Pulso, the monthly newsletter published by Medellin-based San Vicente Fundacion.
Medellin’s hospital, clinic and dental sector enjoys an expanding reputation for high quality and relatively low prices -- which explains why an increasing number of resident expats and medical tourists come here for all sorts of surgical procedures.
On the heels of finalizing a US$50 million strategic investment deal with U.S.-based Christus Health last month, Colombian health insurer and clinic operator Coomeva is moving to rationalize its service network and shore-up its financially troubled “Coomeva EPS” subsidiary.
