Durante el pasado mayo, la Administradora de Recursos de la Salud (ADRES) realizó transferencias por un total de $6,40 billones a las Entidades Promotoras de Salud (EPS), Instituciones Prestadoras de Salud (IPS) y proveedores de servicios y tecnologías médicas. Estos recursos se destinaron para cubrir los servicios de salud de los afiliados tanto al régimen contributivo como al subsidiado, a través de los mecanismos de Unidad de Pago por Capitación (UPC) y Presupuestos Máximos.
Con respecto al aseguramiento en salud de los afiliados al régimen subsidiado, la ADRES realizó transferencias por un total de $2,91 billones. De esta cantidad, $1,27 billones (correspondientes al 43,56%) se destinaron a las EPS, mientras que los restantes $1,64 billones (equivalentes al 56,44%) se giraron directamente a 2.744 IPS y proveedores de servicios y tecnologías médicas. Cabe señalar que las instituciones y proveedores fueron autorizados por 27 EPS que implementaron el sistema de giro directo.
Para los usuarios del régimen contributivo, el banco de recursos de la salud giró $3,29 billones, derivados de los 4 procesos de compensación ejecutados en mayo de 2023 y que se distribuyeron de esta forma: $3,12 billones para financiar los servicios y tecnologías en salud (monto equivalente al 94,98%), $120.664 millones (3,67%) para la provisión de incapacidades por enfermedad general y $44.304 millones (1,35%) para que las EPS lleven a cabo las actividades de promoción de la salud y prevención de la enfermedad.
En cuanto a los recursos UPC del contributivo, se giraron $13.955 millones (0,45%) de manera directa a 187 prestadores y proveedores de servicios y tecnologías en salud, en nombre de las siguientes EPS: Comfachocó, Savia Salud, Capresoca y Emssanar. Además, la ADRES realizó giros a las EPS por un monto de $80.375 millones, correspondientes a 12.419 licencias de maternidad, 5.517 licencias de paternidad y 561 fallos de acción de tutela.
Balance de los giros hechos por la ADRES en lo corrido del año
En el periodo comprendido entre enero y mayo de 2023, la ADRES ha realizado reconocimientos por un total de $30,51 billones para el aseguramiento de los afiliados al Sistema General de Seguridad Social en Salud (SGSSS). De esta suma, se giraron $15,96 billones para el régimen contributivo y $14,55 billones para el régimen subsidiado. Además, se han reconocido un total de $380.315 millones destinados a licencias de maternidad, paternidad y fallos de tutela.
En comparación, durante el mismo periodo del año fiscal 2022, se realizaron reconocimientos por Unidad de Pago por Capitación (UPC) por un total de $25,90 billones. De esta cantidad, se giraron $14,13 billones para el régimen contributivo y $11,77 billones para el régimen subsidiado. Asimismo, se efectuaron reconocimientos por un monto de $353.302 millones para licencias de maternidad y paternidad.
En consecuencia, el valor girado por concepto de UPC en el régimen contributivo experimentó un aumento del 12,95%, mientras que en el régimen subsidiado el incremento fue del 23,67%. Por otro lado, el reconocimiento de licencias de maternidad y paternidad registró un aumento del 7,65%.
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