00:10Welcome and welcome to Voces Reimaginemos, a space where every 15 days we talk with activists,
00:16academics and experts about equality in Colombia. Today we are going to talk about the
00:21issue that is in the mouth of everyone, the reform to health, and we are going to talk
00:25about Jonathan García, an expert in health issues that is also working from the University of Harvard
00:32in the Laboratory of Innovations in Health.
00:36Those changes that come are going to be interesting because we really don't know how to materialize this proposal.
00:43One of the issues are the public hospitals. Historically, there is no important investment
00:49to strengthen the public hospitals in the country.
00:52How to strengthen the public with all the implications that it has from huge investments,
00:57that there is no clear where the resources are going to come.
01:00How to think about health from a population to a territorial model.
01:04How to build networks in places where the demand of services is not as high,
01:09like for example in the areas of rural disperses,
01:11and it ended up leaving a lot of vacations in many communities in the country.
01:17This reform is looking to close that gap.
01:19The new EPS, which is this EPS mayoritariamente public,
01:25will come to the places where no are going to be the other EPS.
01:30We are aware of how much resistance would have the new EPS
01:34to assume a new number of affiliates,
01:36and above all in places so dispersed in the country.
01:40The problem is if with those new affiliates
01:42can offer the same level of service.
01:45It is not easy and it will take many years to the state of the Colombian
01:49to strengthen that public network,
01:52even with all the investments that want to be made.
01:54It is a global tendency
01:55that talks about the majority of the things
01:58that we will have to do in health,
02:00we will be able to do,
02:01we will be able to do in these primary care centers
02:03that are very basic and that would have to do to everyone close to their home.
02:07I think one of the big challenges
02:10is first, in large cities,
02:13how to connect those centers with networks
02:16and for me it is like one of the biggest interrogations
02:19that has this reform,
02:21these issues of the integrated networks
02:24because what we say is that, for example,
02:26the EPSs are going to coordinate
02:28to create networks
02:29and these networks are the ones that are going to attend
02:32the people, not in the primary,
02:34but in the secondary and third,
02:36for example, in the surgery.
02:37I still don't know how to organize these networks
02:42and if they are going to compete between them,
02:44those that if they don't generate utilities,
02:46they have to be closed
02:47and that can end affecting
02:50to the patients in the long term.
02:52All the discussion is in how to do
02:54how to do that transition.
02:57There is always a risk of doing it
02:59in a very repentant way,
03:01but on the other hand,
03:02there are some needs of change urgent
03:05that we can not take 10 years,
03:07so I wanted to ask you a little bit
03:09about how to do this issue
03:10of the risks and the time.
03:11What I think is complicated
03:13and with what I do not agree
03:14is how to consume so many changes
03:17in one alone.
03:18That is the problem.
03:19If we, for example,
03:20we would have a commitment
03:20to maintain the health system
03:23in its structure
03:25as it is today,
03:26but to make these investments
03:27at the level of public hospitals,
03:29it would be very good.
03:31But then,
03:32we are not only going to send
03:33many resources
03:34to this type of investments
03:36in infrastructure,
03:37but also,
03:38to redefine
03:39how to function
03:40the health system
03:41for all the population.
03:42And that is what I think
03:43that two big things
03:44are quite dangerous.
03:47My concern is that
03:49this type of systems,
03:51when they become only publics,
03:54generate a division
03:56in the population,
03:58because then,
03:59the services,
04:00for example,
04:01of medicine prepaid
04:02or health services
04:04find an opportunity
04:05to sell
04:06some services
04:07with private networks
04:10that, for example,
04:11find that
04:12the taxes,
04:13for example,
04:14of the public sector
04:14are not as good
04:16as what would be
04:17to pay someone
04:17from their pocket,
04:18and the public sector
04:20then,
04:20then,
04:20it creates less offers
04:21and that,
04:22it generates
04:23a worse attention,
04:24because there are more
04:25more problems
04:26to find a specialist
04:28that needs this person.
04:30So,
04:31I think that
04:32it can generate
04:33a greater inequity
04:35in the health system.
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