00:00The UPC must be set using technical criteria and reliable information and have sufficient resources to guarantee service provision
00:08of health services without a prior budget constraint justifying a value lower than necessary.
00:16The capitation payment unit in the Health System for 2027 is not yet defined, but the Court
00:22The Constitutional Court has already set several conditions for the government to calculate it.
00:25And one of the main reasons is that the difficult fiscal situation the country is going through cannot be on its own
00:31just an excuse to set a UPC below what the system technically needs.
00:37But let's take it one step at a time.
00:38The UPC is the money that the State recognizes for each member to finance the services and technologies they provide.
00:44part of the Health Benefits Plan.
00:46And during the last few years, one of the major discussions within the system has been precisely whether that money is enough or
00:52not to cover what patients need.
00:54Now, the Court has just entered that discussion again.
00:58In a recent ruling, it establishes a series of parameters that the Velarde de la Esprilla government must follow in order to
01:03calculate the UPC of 2027.
01:05Let's explain them briefly.
01:07The first thing the Court orders is that the Ministry of Health must demonstrate that the resources are sufficient to finance the
01:13services.
01:13And for the Court, this implies that the calculation must be made based on the actual needs of the system, taking into account
01:19taking into account factors such as the use of services, the burden of disease, the aging of the population and
01:24costs of medicines and technologies.
01:27Note that the high court tells the Ministry of Finance that once the Ministry of Health technically determines how much it needs...
01:33The system must adopt the necessary budgetary and financial measures to guarantee these resources and their timely disbursement.
01:39The Court is quite explicit. The technical determination of the system's funding needs must find budgetary support.
01:46sufficient, so that fiscal constraints do not lead to setting a UPC lower than that required to adequately finance
01:54the services and technologies covered by this source.
01:57The second thing the Court orders is that MinSalud must calculate how much backlog has accumulated from previous years.
02:03The high court points out that problems in the way the UPC was calculated over several years may have left
02:09a difference between the money that was recognized and the money that was actually needed.
02:13The Court believes it is necessary to acknowledge this backlog in order to correct it.
02:17But be aware, the court makes two clarifications here.
02:21The first is that not all of the CPS deficit can be attributed to an insufficient UPC.
02:26The Ministry of Health will have to separate what actually corresponds to needs that the UPC should cover.
02:31Other problems include management difficulties, inefficiencies of the EPS, historical obligations, or problems in the flow of resources.
02:39And the second is that once the extent of that lag is established, its correction can be done gradually.
02:45The Court acknowledges that this may be an important area and that fiscal conditions may make it necessary to distribute that area.
02:51correction over time.
02:53But again, it sets a limit.
02:55That gradual approach cannot be used to set a 2027 UPC below what is technically needed to
03:02to finance this year's services.
03:04And the third order established by the Court is that the 2027 UPC must guarantee that of the regime
03:10The subsidized amount will not be less than 95% of that of the contributory scheme.
03:15It should be remembered that for years the UPC of the subsidized regime has been lower than that of the contributory regime,
03:20even though we all have the right to the same health benefits plan.
03:24The Court has been ordering for years that this cannot continue to happen.
03:28However, the court itself points out that these obligations have not been fulfilled.
03:32Now, for 2027, the Court indicates that the comprehensive UPC of the subsidized regime must be at least equivalent to 95
03:40% of that of the contributory scheme,
03:42unless there is sufficient, up-to-date and technically sound information that justifies a greater difference.
03:48Now the ball is in the government's court.
03:50The Ministry of Health will have to calculate the UPC for 2027.
03:54Following those parameters and no later than January 15, 2027,
03:58You must provide the Court with the methodology, the information used, and the technical justification for the defined value.
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