STUDY OF THE REGULATORY FRAMEWORK FOR THE SOCIAL SECURITY SYSTEM IN HEALTH

The analysis of the problem of the SGSSS (General System of Social Security in Health) in Colombia highlights the need of a regulation that ensures the sustainability of the SGSSS by setting two basic elements of the population insurance: benefit plans and the premium value. 

Benefit plans, basically the compulsory health plan (POS), is a homogeneous product or unique plan that health promotion enterprises (EPS) should offer to its members; on the other hand, the capitation payment unit (UPC) is the cost or premium that is recognized to these entities to cover to cost of POS –including administration fees-; and share payments, or user contribution when they receive a health care, in the form of copayments or coinsurance fees, that seek to mitigate the moral hazard and help finance the POS. 

So, the project aims to the development of studies, research, methodologies, models and projects needed to define and adopt a regulatory framework for the General System of Social Security in Health, where it is assure that: 1) The adequacy of the capitation payment unit, 2) the financial balance of the System, 3) Minimum rates system, 4) Update benefit plans of the subsidized and contributory scheme, 5)  Models and methodologies that allow its definition and its update, ensuring the participation of citizens and stakeholders and the dissemination of all the administrative acts adopted throughout the national territory. 

Person in charge:

Executive Coordination, Adriana Carolina Camacho Roa, Planning consultant.