Pilot with teachers confirms Petro’s fears about health improvement

The crisis in the teachers’ health system is confirming the worst fears expressed about the health system that President Gustavo Petro wants to implement in his reform. “This is an example of the health that the president wants,” said Health Minister Guillermo Alfonso Jaramillo about the new system being implemented for the more than 800 thousand teachers in the country. On May 1, three weeks after it was implemented, Jaramillo’s pilot does not have clear routes to get care or medicine providers.

Experts and the opposition have raised fears about the reform, which would affect the EPS’s approximately 50 million members. Among them, the lack of clear responsibilities for actors in the system, incentives for clientelism and corruption, and fear of a chaotic transition that affects public spending and pay in lives. “They are taking us on a death walk as a result of the reform,” Victoria Avendaño of FECOD’s executive committee, the only person to vote against the system’s implementation, told La Silla.

The crisis comes as the government is trying to build consensus to present a new health reform in the next legislature, with the oxygen it got from the agreement with the EPS. The image, now, is of a minister who washes his hands of teachers’ health problems and points to an unknown and questioned official, Jhon Mauricio Marín, president of Fiduprevisora, the entity that manages Fomag, a millionaire fund with which teacher health care is paid.

A system without responsibilities or capabilities

One of the main criticisms against the governmental model is the lack of clear responsibilities for the actors in the system. The flaws still exist in the reform agreed with the EPS. Many of its main functions, such as the creation of a network of clinics and hospitals, or health risk management, remain distributed among several entities, with the danger that in the end no one will be responsible for them.

For this reason, the path for improvement of the patient is not clear. That is to say, with the current project, the steps for a patient to request an appointment with a specialist, claim a medicine or lodge a complaint about poor service remain confusing.

The crisis in teachers’ healthcare system is showing the impact of this lack of responsibility.

In some audios revealed by La FM, Minister Jaramillo and the president of Fiduprevisora, Marín, are seen discussing hiring IPS as suppliers of medicines for the system. While Marín refuses to consider IPS as a supplier, Jaramillo pressures him to do so. According to Marín, the order not to contract with IPS came directly from the president. The minister appears in the audio to convince him, saying, “This is a moment of emergency (…) then we do what the president says.”

The lack of clarity about essential elements of the system, such as the provision of medicines, has tangible effects on people.

In Valledupar, retired teacher Mavis del Portillo, 64, has not received medicine for several ailments since May 1. These include high blood pressure, osteoarthritis and diabetes. The teachers, who are charged from their pensions to contribute to the system, say that last week, after a meeting between teachers and fiduciaries, they were informed that they would be able to pay at the Eticos y la Fe drugstores. Will be able to claim your medicines.

“I contacted them and they told me that they have not been hired, nor do they have any information about the teachers. Nor the staff to assist us,” says del Portillo, who worked as a teacher in public schools for 32 years. “There is no stick that can shade us on our health issue.”

Minister Jaramillo has also not taken any responsibility for the crisis. During the debate on political control in the Senate on Tuesday, he targeted the culprits for about an hour. Among them, the media, the former operator of the teachers’ health system and, above all, Marín and his team at Fiduprevisora.

Jaramillo’s main argument is that Marín did not want to implement in detail the new model that the government and FECOD had agreed upon. He even said that within Fiduprevisora ​​he did not feel that he was listened to, and that the unit’s officials tried to torpedo his work all the time. “I feel disappointed,” Jaramillo said at the Senate’s Sixth Committee, where he absolved President Petro of all responsibility.

But questions about the fiduciary authority as the main manager of the system were circulated within higher government. “This is an entity full of dark political interests. It does not contain concrete information about teachers or equipment to avoid excessive expenses within the system,” a senior education ministry official, whose portfolio includes Fomag, told La Silla Vecia, who requested that he not be named. Be hidden. As if you don’t have a spokesperson.

Incentives for corruption and clientelism

Another major criticism of Petro’s health model is that it has resulted in a corrupt and clientelistic system. Above all, due to the creation of figures such as departmental and district health directorates, which can be co-opted by local politicians, and mayors and governors retain the power to choose the directors of public hospitals and state social enterprises.

That criticism is fueled by questions asked of Marin, the president of Fiduprevisora. According to Voragin, the government-appointed lawyer, promoted to office in April 2023 by La Yu Party congressmen Sarai Robayo and Wilmer Carrillo, is also involved in a bribe payment scandal that is being prosecuted. Before LA U’s senator Antonio Correa Jiménez at the Supreme Court.

Indeed, Minister Jaramillo argued in the Sixth Commission that Marín is corrupt. He said that he appointed his “friends” to the regional directorates of the new system, taking quotas from the former operators of the system, that he was favoring the IPS linked to those operators, and that his contracting model was similar to the one he promoted when he was in charge of the Social Security Fund of the Colombian Railways, from where he came with the investigations of the Attorney General’s Office.

But there were signs of corruption from Fiduprevisora ​​and its management to Fomag. In fact, former Education Minister Alejandro Gaviria tried to create another institute in the National Development Plan to manage money from the teaching fund, and even President Petro publicly condemned corruption within the fund.

“The big change in the model is that of hiring an employee who poorly manages his company’s finances and being promoted so that he now also manages the inventory, human talent and the commercial area,” says Hernando Bayona, a former deputy education minister. “Fideuprevisora ​​does not have the technical or human capacity to be the center of such a complex system.”

Small cases of clientelism are occurring due to the frustration of patients in the teaching system.

On April 30, Professor César Manjarrez’s niece was scheduled to undergo surgery in Valledupar to remove a mass in her pelvis that was apparently malignant. That day was, in fact, the last day of the old teaching model and the Foscal-CUB Integrated Network, which serves teachers in the capital of César, canceled the surgery because the agreement with Fomag had expired.

To help his niece, who is also a state teacher, Manjares says he reached out to his contacts in the FECOD executive committee to help reschedule the surgery through fiduciary. “They helped me. They rescheduled it for May 28. But it’s not fair that someone has to search or suffer,” says Manjarrez, who is 58, has high blood pressure and needs his One has to spend money from one’s own pocket to buy pills to control blood pressure.

A chaotic transition and excessive spending

“Today there are more than 26 million Colombians in the intervened EPS and there could be even more if we do not agree on a peaceful and orderly transition,” Ana María Vesga, president of Acemi, the EPS association of contributory governance, told El Tiempo. They reached an agreement with the government to introduce a concrete health reform.

One of the great fears of the petro-health system is that its transformation will be chaotic. And that is what is happening with teachers.

In Marin’s intervention before the Senate, he admitted that the model began without a solid database to serve teachers, nor did they have a network of drug suppliers to meet their demands, and he even ​It was reported that the former operator of the system was creating obstacles in accessing the medical records of patients.

“As of now we are building the capacity to keep medical records. But we can’t expect that something happens overnight on April 30 and we wake up the next day with a medical record that is interoperable,” Marin said before the Senate. “This is a system under construction, but it is constantly being improved.”

Then, in his speech, Jaramillo pointed out that the contract that Fiduprevisora ​​is paying for primary care for teachers is too expensive, and puts at risk the money to pay for more complex procedures like orphan diseases or cancer treatment. Jaramillo’s comments highlight one of the biggest fears of the new health system: excessive spending, now without EPS managing the financial risk.

To explain this problem, Jaramillo once again defended himself with the argument that the model designed is not being implemented by Fiduprevisora. Meanwhile, in the real model, hundreds of thousands of teachers in Colombia are without health.