Suramericana, Sanitas, Aliansalud: Top 3 ‘EPS’ Health-Insurance Networks in Colombia

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.