Risk of medical health liability of an eso (State social enterprise): asymmetries in the frequency of care

Abstract

This text observes and analyzes the risks of medical-health responsibility on the part of a state social enterprise (ESE), Valle del Cauca, Colombia. It is based primarily on the rates of decrease of frequency in the attention of health service users as a consequence of the autonomy in the application of the "technical notes" of the IPS (institutions providing health services), as of decree 441 of March 28, 2022. The methodology corresponds to a systematic review study, which allows an analysis of the data provided by an ESE (Empresa Social del Estado), representative of Valle del Cauca during the period of validity of 2022. The review exercise reports the new contracting models, the agreement of wills, the technical notes and the prospective payment modalities in an annex that is an integral part of the agreement. The exercise reveals and gives as a result that, upon validation with the institutional historical data, the asymmetry of the data provided in the "technical notes" does not coincide with the frequency of use of institutional health services and technologies in the last five years. Subsequently, there is evidence of a significant decrease in the user's health care services, the effect of which is demarcated in the benefit per event that would not be paid to the different entities due to the great lack of specifications in the "technical note". What is evident is that they take the values of the capita and the event to the note, that is to say, it is proposed to pay a lower rate than what is billed, now adding the capita and the event (the note goes to 321 million in the note, and the capita is currently 307, without adding the event). Another important fact is that the note fixes a consultation frequency that compared with the historical 2021, are below, they propose that for each patient attended, at least three consultations are not made; when comparing with the data of 2022, for the month of September the annual goal would have been met, that is, from October to December, attention and/or consultation would no longer be provided to the users of representative companies; from this perspective, there is an economic increase and a strongly decreased result in terms of consultations, but really in terms of money, the result will be lower.