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“Salud: Estado de completo bienestar físico, mental y social, y no solamente la ausencia de afecciones o enfermedades, es un derecho humano fundamental”
(Definición de la conferencia internacional para la Atención Primaria en Salud, AlmaAta, URSS, Septiembre de 1978).
Este derecho nunca se ha garantizado en la historia colombiana, gracias a que los conceptos y estructuras de la seguridad social han sido introducidos en Colombia copiando modelos de otros países sin tener en cuenta nuestras propias condiciones.
Pero este sistema genera paquetes (kit, combo) de cobertura de “salud” según la capacidad de pago del “usuario”. Es decir, proporciona una salud para ricos, otra para trabajadores y otra para pobres, dejando desprotegida (en la practica) parcial o totalmente a muchos colombianos, que no son mirados como pacientes, sino como clientes. Esto demuestra que el modelo es netamente economicista y deja de lado el impacto que pueda producir sobre la salud de la población.
El problema no es la falta de recursos. La salud mueve al año cerca de 38 billones de pesos y tiene mas de 12 fuentes de financiación, entre las que se cuentan las regalias de pozos petroleros, los impuestos al tabaco y al licor y los fondos municipales. Por esto, dice Juan Gossain: “La paradoja más grande y más dolorosa es esta: nunca antes habíamos tenido tantos recursos para la salud de los colombianos, pero nunca antes el sistema de salud había estado en una situación financiera tan crítica”.
Si bien el gasto en salud no es infinito, la voracidad de ganancia de algunos empresarios, sí lo es. El sistema le ha entregado el poder a las EPS (Empresas Promotoras de Salud) para definir mecanismos para la prestación de servicios, y como estas empresas no estàn hechas para salvar vidas sino para ganar plata, han ideado cada vez mas métodos para restringir el acceso de los usuarios a la salud, bajar la calidad en la atencion, enredar los tramites y, pese a todo, seguir cobrando y recobrando. Se han robado la plata de la salud de los colombianos durante 18 años.
La cosa es que se pone en competencia a los hospitales públicos con las clinicas privadas, pero las EPS favorecen en la contratación a las clinicas de su propiedad en desmedro de la red pública, sumándole a esto que demoran (las EPS, el gobierno nacional y las aseguradoras) los reembolsos, o nunca los realizan. Es decir, que los hospitales prestan los servicios y nadie se los paga.
En este momento la deuda a la red publica hospitalaria asciende a casi 10 billones de pesos y la única salida que encuentran las instituciones es reducir la calidad para mantener las puertas abiertas. Sin embargo, el sector está agonizando. Los hospitales están quebrados, y los trabajadores de la salud están sin salarios dignos (en ocasiones sin ningún salario).
El personal de la salud se ha visto coartado por los lineamientos de las EPS, a los médicos de consulta externa les piden reducir el tiempo de atención, limitan los medicamentos que pueden recetar y las enfermades a tratar, los centros de salud no cuentan con insumos básicos. La autonomia profesional y el criterio médico se han anulado.
El sistema de salud tiene dos bases de datos: Contributivo y Subsidiado. Entonces las EPS y Hospitales como atienden ambos tipos de pacientes, hacen cobro y recobro, duplicando los usuarios o inventándolos (tutelas nunca atendidas, pacientes ya muertos) y generando desorden, mientras se desfalca al sistema.
El derecho a la salud se vulnera en muchos ámbitos, sintiéndose drásticamente en el servicio de urgencias, donde se niega la atención, colapsan los hospitales y se mueren los pacientes en la puerta.
Por todo esto podemos decir: El sistema no funciona, no aguanta mas remiendos, ni salidas fáciles, ni pañitos de agua tibia.
Presentamos el “Proyecto de Ley estatutaria por el derecho fundamental a la salud” construido por diversos sectores políticos, sindicales, académicos y populares que se unieron para proponer un modelo que garantice efectivamente el acceso a este derecho.
Citando la segunda parte de la declaración de Alma Ata:
“… y que el logro del grado más alto posible de salud es un objetivo social sumamente importante en todo el mundo, cuya realización exige la intervención de muchos otros sectores sociales y económicos, además del de la salud”.
Esta propuesta se puede sintetizar así:
El reconocimiento efectivo de la salud como un derecho fundamental y no como un negocio.
¿Cómo?
- Que el Estado asuma como garante de dicho derecho a la salud (en cuanto lo respeta, protege y garantiza)
- Que se elimine la intermediación financiera con ánimo de lucro.
- Que exista una atención integral a la salud, sin paquetes de beneficios.
- El reconocimiento de la diversidad poblacional (diferencias regionales, urbano-rurales, de edad y genero).
- La creación de un Sistema Único Descentralizado de Seguridad Social en Salud, llamado: SUDSSS.
- Financiamiento público, con un Fondo Único nutrido por aportes fiscales y parafiscales, y una central unica de recaudo.
- Ampliar la participación en la formulación de políticas, en el funcionamiento, vigilancia, veeduria y evaluación del SUDSSS
- Defender el carácter intersectorial de la salud, que obliga a la coherencia de las politicas en todos los aspectos.
Es, finalmente, que el estado reasuma la obligación de garantizar el derecho a la salud, que se eliminen los intermediarios y se cree un único fondo que recaude recursos y pague cuentas; que la base de información sea única para que no se excluya a nadie de ningún servicio en ningún hospital o ninguna clínica; redistribuir los territorios en salud para que los municipios tengan mayor autonomía; aumentar las acciones en promoción y prevención para que la atención sea solo un complemento; y permitir la participación y veeduría ciudadana permanente.
Suena muy coherente, completa, sin fisuras.
Nosotros suscribimos la propuesta. Como sabemos que la crisis de la salud en Colombia no es un problema de déficit presuspuestal, sino falta de analisis epidemiologico, afán de lucro, ausencia de Promoción y Prevencion de la salud pública, malas condiciones laborales y deshumanización, estamos de acuerdo con el Proyecto de Ley estatutaria en tanto pretende mejorar todos estos aspectos, sin embargo tenemos algunos temores.
- ¿Cómo permitir la articulacion con el sector privado, sin que el afan de lucro de este sector corrompa el sistema?
- Que el estado asuma (sin excusas) convertirse en regulador y proveedor de salud.
- Los multiples frenos que apareceran al enfrentar a poderosos enemigos politicos y financieros (EPS y Aseguradoras) que no se van a dejar quitar tan facil el lucrativo negocio que han hecho con la salud.
Estamos pidiendo algo irreal en este país: salud y justicia al mismo tiempo.
Otro temor es que el proyecto que estamos presentando puede ser distorsionado y manipulado siendo aprobado como ley estatutaria una propuesta alejada de la inicial, por eso hay límites dentro de la negociación, los inamovibles que en caso de modificarse se retiraria el proyecto, son:
- Que la salud se conciba como un derecho fundamental
- Que no se permita la intermediaciòn financiera con animo de lucro
- Defender el caracter intersectorial de la salud, debe incluir una activa participación ciudadana en veeduria, legislación y control.
Este Proyecto de Ley estatutaria se está discutiendo a nivel nacional con otras dos propuestas:
- Una del gobierno nacional que apunta a corregir el atasco de los fondos para la red hospitalaria y propone un mayor control financiero.
- Un proyecto del partido de la U que propone por vía legislativa redefinir el papel de las EPS en lo que se conoce como administración regulada. Continúa con la intermediación financiera y sostiene los paquetes de beneficios según el pago, ademas de debilitar la tutela. (Esta es la propuesta que presenta Roy Barreras y en algunas páginas, incluso la del senado, pretenden confundir con este proyecto de ley estatutaria. Dicho de otra manera, Roy Barreras no nos representa, su propuesta no es acorde a la nuestra *
En el dia de ayer (2 de Octubre) se archivó en la Camara de Representantes una iniciativa parlamentaria no articulada a este proyecto de ley, pero parte de la “Alianza por un nuevo modelo de salud”, el que esta propuesta se hunda en la Cámara nos da una idea de lo que puede pasar con el proyecto de ley estatutaria en el senado, si no recibe un respaldo ciudadano.
Para que los mercaderes de la salud no nos quiten el derecho a tener una salud real: Mire, difunda, critique lo que quiera, pero eso sí: No sea indiferente.
!Por un nuevo modelo de salud¡
