Wednesday, 9 May 2018

Colombia's EPS: All in its own good time

After over six years based in Bogotá we've experienced many aspects of Colombian life, from the hugely enjoyable to the utterly frustrating.

However, there's one thing that, thankfully, we've yet to sample (and hopefully never will): The health service (well that and scopolamine).

OK, we've had to get some dental work done, but that was a private affair, not through any health scheme, and not a sickness issue either — having front teeth isn't completely essential, is it? (On that, um, front, it did take some time to find a trustworthy, reasonably-priced dentist. We got there in the end, though.)
Sura EPS: Regarded as one of Colombia's best in this regard.
Sura: Seen as one of the best EPSs out there ... (Image from Facebook.)
That aside, the 'opportunity' hasn't arisen to use an EPS ('Entidad Promotora de Salud', health promoting entity), the somewhat private health service that's the default option for the majority of Colombians.

Basically, for a relatively small monthly fee you get what results in pretty much free health care when the need arises.

For the very poor there are other, government-subsidised options, while private health insurance is a more attractive alternative for wealthier Colombians. Yet going through an EPS is where it's at for most.

There are many of them to choose from, all operating in more or less the same way. Naturally enough, some are rated better than others — the EPS you use determines which clinic or hospital you get sent to for any specialised treatment you may need.

Thus, they function as a sort of middleman between you and the medical specialists. Minor issues are generally dealt with by a GP at an EPS clinic.

For problems of a more serious nature, but not emergency life-or-death ones, your EPS has to grant approval before any treatment is given. It does foot the bill after all — with a little help from your small monthly contribution of course (and the government in some cases).

So that the EPS has to give prior authorisation is fine, in theory. In practice, however, it can lead to a lot of time wasted waiting in line just to get signed off for surgery or whatever.

Take the case of a friend who was in a bicycle accident recently. His EPS sent him to hospital — unnecessarily by ambulance as it was — for an X-ray on his injured arm. The doctor who saw him first up was unsure if surgery was needed or not. Further examinations were required to determine that but they couldn't be done at that specific time.

Our friend got a temporary cast on his arm and was told he'd have to come back to fully ascertain the extent of the damage. But before that could happen, he had to return to his EPS to get the green light.

In short, for practically every additional step in his treatment he had to keep on going back to the EPS for official approval. The result was that a whole three weeks passed from the date of his accident before he was told surgery was necessary. And, before that surgery could actually happen, the EPS had to give the official stamp of approval. All rather convoluted.

Nonetheless there is some method to this medical madness. It helps to ensure that the EPS isn't forking out for unnecessary, costly procedures.

You see, so it goes, some of these institutions have been rather lax, in a beneficial way albeit, about their patients' needs, resulting in their accounts requiring some emergency treatment of their own.

Somebody eventually has to pay for expensive medical operations. And somebody has to, or at least should, pay the professionals carrying them out. That doesn't always happen in the Colombian health service. We've heard stories of doctors waiting months for their remuneration.

Being that as it is, we're happy not to be an extra burden on the system. Long may it stay that way.
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