En el primer año de implementación del giro directo ampliado, la Administradora de los Recursos del Sistema General de Seguridad Social en Salud (ADRES) ha transferido más de $57 billones de pesos a Instituciones Prestadoras de Servicios de Salud (IPS) y proveedores de tecnologías en salud, consolidando esta estrategia como una de las transformaciones más significativas en el flujo de recursos del sistema de salud colombiano.
La medida, adoptada mediante el Decreto 489 de abril de 2024, establece que las Entidades Promotoras de Salud (EPS) obligadas a giro directo deben postular al menos el 80% de los recursos correspondientes a la Unidad de Pago por Capitación (UPC) directamente a prestadores y proveedores. A partir de esta disposición, la ADRES realiza las transferencias una vez se finaliza la liquidación mensual de la UPC.
Más de 7.200 IPS beneficiadas mensualmente
De acuerdo con cifras oficiales, entre abril de 2024 y abril de 2025, un promedio mensual de 7.291 IPS ha recibido pagos directos desde la ADRES. De los $57 billones girados, $25.57 billones corresponden al régimen contributivo y $31.5 billones al régimen subsidiado.
Este nuevo esquema ha permitido mantener una distribución de recursos con mayor regularidad y control, al tiempo que se fortalece la liquidez en las clínicas, hospitales y proveedores del país. Según explicó el director de la ADRES, Félix León Martínez, los pagos se han venido realizando con una precisión operativa destacable:
“Se están girando todas las semanas a más de 3.500 clínicas y hospitales por el régimen contributivo, y todos los meses a más de 3.700 IPS, con recursos correspondientes al régimen subsidiado, con precisión cronométrica. Ya son 57 billones de pesos los girados directamente a prestadores en un año de vigencia de la norma”.
Proyecciones de crecimiento y ajustes normativos
La ADRES anticipa una mayor participación del giro directo dentro del esquema de financiación del sistema de salud. Según anunció Martínez, nuevas EPS se han sumado este año al modelo de giro directo, ampliando la cobertura de esta estrategia financiera que busca mejorar el flujo de recursos, reducir intermediación y garantizar mayor transparencia.
Además, se encuentra en trámite una nueva resolución del Ministerio de Salud y Protección Social que podría incrementar el porcentaje de giro directo del 80% al 90%, junto con medidas complementarias orientadas a optimizar la distribución de los recursos.
“Está propuesta una resolución en el Ministerio de Salud para aumentar el porcentaje de giro directo al 90 % y distribuirlo mejor, limitando los giros a las IPS integradas verticalmente con las EPS”, precisó el director de la ADRES.
Giro directo: una herramienta clave para la sostenibilidad
El modelo de giro directo se ha convertido en una herramienta clave para la sostenibilidad del sistema de salud, al permitir que los recursos públicos fluyan de manera más controlada y directa hacia los actores que efectivamente prestan los servicios de salud. Su ampliación responde, entre otras cosas, a los constantes llamados de clínicas, hospitales y asociaciones gremiales que han solicitado por años un flujo de recursos más predecible y oportuno.
Al eliminar, en buena medida, el riesgo de intermediación financiera por parte de EPS que no cumplen con sus obligaciones, el giro directo fortalece la capacidad operativa de la red prestadora y permite una mayor trazabilidad del uso de los recursos.
El reto de la integración vertical
Una de las propuestas que acompañan el incremento del porcentaje de giro directo es la limitación de pagos a IPS integradas verticalmente con las EPS. Esta práctica, común en algunos sectores del aseguramiento, ha generado controversias sobre la eficiencia, la transparencia y el uso de los recursos públicos.
El ajuste propuesto busca reducir posibles conflictos de interés y promover una asignación más equilibrada de los recursos del sistema. De implementarse, esta medida podría reconfigurar el mapa de relaciones financieras entre EPS y su red de atención, obligándolas a contratar con prestadores externos bajo condiciones más equitativas.
De acuerdo con la entidad, a un año de la entrada en vigor del Decreto 489 de 2024, los resultados del giro directo ampliado son significativos. Más de $57 billones han sido transferidos directamente a prestadores de salud en todo el país, beneficiando mensualmente a miles de clínicas, hospitales e IPS. Las proyecciones apuntan a un aumento del porcentaje de giro y a ajustes regulatorios que podrían reforzar aún más la transparencia y eficiencia en el uso de los recursos del sistema de salud.
La ADRES, bajo la dirección de Félix León Martínez, se consolida así como un actor técnico con capacidad operativa para implementar reformas que impacten positivamente la sostenibilidad del sistema y el acceso efectivo a los servicios de salud para millones de colombianos.
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