What is the EPS criteria to order a covid-19 exam or not to do it?
The criteria are not defined by the EPS, but by the Government, through guidelines from the Ministry of Health, which have changed as the pandemic progresses and science is progressing. The idea that everyone had to be tested was wrong. It was clear, one, that it is no longer necessary to give the test to who was officially declared as infected, 14 days was confined and the symptoms have passed. Until a couple of weeks ago, that person had to have a second test, not anymore.
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What other criteria have changed?
Two, if you are a relative of an infected person and live with him, you must presume that he has covid-19 and must isolate himself and notify his contacts, without the need for proof. And, in a stage in which we are already, which is called community spread of the epidemic, the tests are no longer so important in general. The message that is important, and hopefully this could be highlighted, is: if you have been close to a close contact, if you have the intuition that you are suspicious, behave as if you have covid-19, isolate yourself and notify your contacts.
There are complaints about delay in testing when they are important. Are they trying to shorten the delivery of results?
I dare say that in the last week we are already beginning to see an improvement. But let’s talk about the structural problem. The superintendent of Health said, in his report a long week ago, that on average, the health system was managing to deliver results in three days, 72 hours, which is very close to what was desired. In other words, we are delivering the result to the bulk of the population when it is useful and when it is expected.
But, of course, in a situation in which neither this country nor any other had ever had to perform such complex tests, which require so much logistical filigree, since there are failures and there are delays in transportation, there is a global shortage of reactive. And reading these tests is not easy, it requires the technical expertise of professionals who have been working 24 hours, 7 days a week, and cannot cope. So the importance of redefining test priorities. And the use of other types of tests, such as antigen tests, has been approved.
The message that is important,
and I wish it could stand out, it is: if you have the intuition that you are suspicious, behave as if you had covid-19, isolate yourself and notify your contacts
Are they the same antibody tests?
They are different. Those of antibodies or serological, fashionable a few months ago, are those that tell if you had the virus. To find out if you have the virus, the standard test is the famous PCR, which is very complicated. But a few days ago, the ministry authorized that to find out if you have the virus, the antigen test is also useful.
And that will greatly ease the burden on the labs?
Sure, because it is much easier to process. So, there are delays with the tests, but thanks to the fact that the EPS began to collaborate with the Government when the pandemic began, because at the beginning they were not expected to do so, the laws did not allow it, it was because we were able to expand the capacity of private laboratories.
Otherwise, we would have depended, as was very early in the pandemic, on the INS laboratory and on the department laboratories, and there, we would have been killed.
As a result, EPSs were doing 35,000 tests a day across the country at the end of last week. Altogether, Acemi has made almost 700,000. That is outrageous. But of course we created a crash down the street in the labs, which we are beginning to overcome.
It leaves me clueless when he says that he was not supposed to have had such a collaboration between the EPS and the Government. How so? In the middle of a pandemic?
I explain. As Law 100 and Law 715 are written, in the event of an epidemic or a public health emergency, those who must carry out epidemiological surveillance are the National Institute of Health and the departmental authorities.
What corresponds to the EPS is to care for the sick. But epidemiological surveillance, which involves taking the sample, processing the tests, tracing contacts, cutting the epidemiological link, everything we have learned these days, that did not correspond to EPS by law. And, in fact, those laws are still in force. If we became jurists and wanted to apply the laws to the letter, we could not have assumed them.
They would simply be waiting for orders to care for the sick, they would not be detecting the cases …
Fortunately, the government realized that it alone was not going to be able. Then, he ordered the EPS to intervene in this part, which was not provided for in the law. But, obviously, they made us do things that were not planned, and that we had to learn. Now, better to have that challenge and that there are failures meeting it than to fold our arms and not do it.
There are also complaints that non-covid patients are having their appointments deferred to September or October …
Of course, there have been some procedures and control appointments, as well as selective surgeries, which we postponed by decision of the authorities. But the bulk of these patients continued to be cared for, at least in the ten EPS that are in Acemi … We have done 740,000 home care since the pandemic began. Five and a half million telemedicine services in four months. In a typical month, no more than twenty thousand such inquiries were made.
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But isn’t there around 35 EPS in the whole country? Does the association only have ten?
What happens is that the bulk are from the subsidized regime and Acemi represents those from the contributory regime. And of those, at the moment we do not have Medimás, whom we suspended for known reasons, and Coomeva, who retired a few months ago. We are left with ten to show.
There are intensivists who complain about how cumbersome it is to fill the Mipres in the midst of this pandemic …
The Mipres is a platform that is applied exclusively for those services that are not in the benefits plan. The treatment of a patient with covid-19 does exist, because it is considered an acute respiratory disease. But the tests, since it was not our turn to do them, were not in the benefits plan, and there it is time to do it for Mipres. That is a massive and very cumbersome thing … We hope that the Government releases us from that obligation.
What can you tell me about the crisis in clinics and hospitals due to the reduction of services other than covid-19?
We asked the clinics to sign up for the covid-19, to create new ICU beds, while we asked non-priority patients not to use their services, and therefore their income was lowered. The most important aid came from a government measure that was much discussed, and that is that they will be paid to maintain the latent infrastructure.
How has the endpoint law worked in the midst of the pandemic?
Final point is the mechanism provided for the State to catch up on the debts it has with the system. The government has not yet rolled a single endpoint peso. This involves technological adjustments, the precision of legal regulations on which invoices are to be paid and which are not, and to hire an audit. The first endpoint monies are expected to start flowing in September.
Are EPS safe and sound with hospitals today? How much money has the government turned to them?
In our estimates, around 8 billion. And we have paid the provider network, suppliers and laboratories, eight billion seven hundred thousand pesos. It means 19% more than what we have received. It was a huge effort to, precisely, help the liquidity of hospitals and clinics.
Many congressmen are saying that when this pandemic ends, EPS will have to disappear …
The question to ask is: how would the pandemic have gone without EPS? As I explained now, on the subject of epidemiological surveillance, the Government had to rely on the capabilities of the EPS to be able to respond in such an earthquake.
And the EPS have been the ones that have allowed the strengthening of hospitals and clinics, the expansion of ICUs, the coordination of the purchase of equipment and others, because they integrate diverse networks.
The country has done better thanks to the flexibility, the capacity for innovation, and the reaction of private organizations such as EPS
How many lives are we managing to save in a pandemic like this? The EPS are private organizations at the service of a public service called health. The country has fared better thanks to the flexibility, the capacity for innovation, and the reaction of private organizations such as the EPS, in the face of a public emergency.
EPSs have introduced innovative covid-19 patient care mechanisms, long before the ministry authorized them.
What would it have been like the expansion of the laboratories, the hiring of the army of people who are taking samples, only applying Law 80 and public procurement and tenders? We would have gone mad.
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Who really pays what a covid patient is worth? Is it the EPS or is it the State?
Great question. In principle, covid-19 patients are expected to be served by EPS, with their routine income, which is the famous UPC, the premium they pay us monthly to serve our members.
Now, when the covid-19 did not exist when the premium was defined, then the Government, with good judgment, said: if the covid-19 cases exceed the number of frequencies that were used to calculate the 2020 premium, when If this frequency is exceeded, the State will pay the covid cases directly to the hospitals. We have not reached that point yet.
If the capacity of the hospitals becomes full, would the EPS be able to attend to patients at home?
It is a little backwards. Thanks to home care, we are managing to prevent hospitals from overcharging. We make a great effort to detect cases in time, measure oxygen at home and monitor through telemedicine, so that patients do not arrive at the hospital. And although we are holding our breath and crossing our fingers, I think that, bad as well, we are succeeding.
Holding our breath yes we are … (laughs)
We are at the peak …
How are relations with the mayor of Bogotá?
I admire her and have personal appreciation for her. She has sometimes scolded us unfairly, but I recognize that she sits down to work to find solutions.
The EPS are obliged to provide Ivermectin, as recommended by the Mayor of Cali?
No. EPS does nothing that the doctor does not order. As far as I understand, this formula does not have the approval of the authorities or scientific societies. But my disagreement with the mayor of Cali is another, and that is that he believes that the solution to the problems is through criminal complaints. No pandemic has been resolved in court.
And I suppose the CGR is bothering them a lot too …
Rather than criticize or praise him, he would make the Comptroller an invitation to sit down to work with us and we explain what we are doing with the resources that the State turns us to face this issue of evidence, which worries him in moment.
MARÍA ISABEL RUEDA
Special for TIME