- PUBLICADO:
ADRES giró $7,14 billones en abril: análisis detallado de la UPC, el giro directo y la sostenibilidad del sistema de salud
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La ADRES reconoció y distribuyó $7,14 billones en abril de 2025 para garantizar la atención en salud en Colombia. A través del giro directo, mecanismo que canaliza los recursos directamente a IPS y proveedores, se giraron $5,56 billones, equivalentes al 78 % del total de la Unidad de Pago por Capitación (UPC). Esta cifra no solo revela el volumen del gasto mensual, sino también la creciente dependencia del sistema en esta herramienta de financiamiento directo.
Este artículo desglosa las cifras, explica las dinámicas por régimen, muestra el comportamiento acumulado del primer cuatrimestre del año y evidencia cuáles son las EPS que cumplen o no con las metas de giro, especialmente aquellas bajo intervención o medida especial.
Distribución del régimen subsidiado: $3,74 billones reconocidos
En el régimen subsidiado, la ADRES reconoció $3,74 billones y giró efectivamente $3,61 billones. De ese monto, $2,88 billones fueron girados directamente a 3.342 IPS y proveedores de tecnologías en salud. A las EPS se les trasladaron $722.701 millones netos, después de aplicar diversos descuentos.
Distribución del régimen contributivo: $3,41 billones reconocidos
En el régimen contributivo, la ADRES reconoció $3,41 billones, de los cuales $2,68 billones se giraron por giro directo a 2.944 IPS y proveedores, y $717.162 millones se giraron a las EPS.
Otros reconocimientos: incapacidades, licencias y fallos judiciales
Además del reconocimiento de UPC, la ADRES giró recursos adicionales a las EPS por diferentes conceptos asociados a derechos sociales y obligaciones laborales. En total, los otros reconocimientos sumaron más de $282 mil millones solo en abril.
Tabla 3. Otros reconocimientos ADRES – Abril 2025
| Concepto | Valor (COP) |
| Incapacidades por enfermedad general | 137.022.419.423 |
| Promoción y Prevención (PyP) | 39.257.566.739 |
| Licencias de maternidad (11.281 casos) | 96.129.316.535 |
| Licencias de paternidad (6.911 casos) | 9.107.389.287 |
| Fallos de tutela (96 casos) | 768.963.087 |
Comportamiento cuatrimestral: $29,90 billones girados entre enero y abril
Entre enero y abril de 2025, la ADRES giró $29,90 billones en total por concepto de UPC. De este valor, $14,88 billones correspondieron al régimen subsidiado y $15,02 billones al contributivo. Estos montos representan un crecimiento del 7,94 % y 5,12 %, respectivamente, frente al mismo periodo de 2024.
Por otro lado, el pago de licencias de maternidad, paternidad y fallos de tutela fue de $402,75 mil millones, con una reducción del 3,65 % respecto al año anterior. Cabe destacar que en los primeros cuatro meses del año, el giro directo a prestadores y proveedores alcanzó los $20,98 billones, un incremento del 99,53 % frente a los $10,51 billones girados en el mismo periodo de 2024.
La distribución fue así:
- Régimen subsidiado: $11,48 billones (54,71 %)
- Régimen contributivo: $9,50 billones (45,29 %)
Este aumento obedece a la implementación del Decreto 489 de 2024 y a las medidas especiales ordenadas por la Superintendencia Nacional de Salud a múltiples EPS.
Concentración del giro directo: los mayores beneficiarios
Los 20 mayores receptores del giro directo concentraron el 24,46 % del total girado entre enero y abril. Los primeros cinco fueron:
En total, estos 20 receptores agruparon $5,13 billones, mientras los 3.884 beneficiarios restantes recibieron $15,84 billones.
Cumplimiento del giro directo por EPS en intervención o con bajo patrimonio: foco regulatorio clave
Uno de los elementos más relevantes del boletín técnico de abril es el seguimiento al cumplimiento de los porcentajes mínimos de giro directo obligatorio por parte de las EPS que se encuentran en medidas especiales, intervención o que no cumplen el indicador de patrimonio adecuado, conforme al Decreto 489 de 2024.
Panorama del régimen contributivo
EPS como Nueva EPS, Sanitas, Famisanar y Coosalud (EPS en medida especial de intervención desde 2023- 2024) cumplen con el mínimo exigido (80%) entre enero y abril de 2025. Por otra parte, EPS como EPS Compensar, Salud Total, Comfachocó y Comfaoriente muestran incumplimiento a la fecha, dado que ingresaron a la medida de giro directo a partir de abril de 2025, como consecuencia del incumplimiento del indicador de patrimonio adecuado definido por la Superintendencia Nacional de Salud.
- Salud Total: 19%
- Compensar: 19%
- Comfachocó: 18%
- Comfaoriente: 20%
Frente a este último punto, es importante señalar que, según el Decreto 489 de 2024 —que establece los porcentajes y condiciones para el giro directo de los recursos correspondientes a la Unidad de Pago por Capitación (UPC) del régimen contributivo y los presupuestos máximos para servicios y tecnologías no financiadas con cargo a la UPC en los regímenes contributivo y subsidiado— se incluyó en el mecanismo de giro directo a las EPS que incumplen con el indicador de patrimonio adecuado.
Para el caso de Cajacopi, esta EPS cumplió con el indicador de patrimonio adecuado de la SNS a partir del 4to proceso de enero de 2025 y reiteró el incumplimiento a partir del 4to proceso de marzo,
periodo durante el cual no estuvo obligada a programar pagos por el mecanismo de giro directo. Y Emssanar y Asmet Salud ingresaron en la medida de Giro directo a partir del 1er proceso de abril de 2025, por incumplimiento del indicador de patrimonio adecuado de la SNS.
Régimen subsidiado: mayor cumplimiento, pero con excepciones relevantes
En contraste, en el régimen subsidiado se observa un mejor desempeño general. EPS como Emssanar (89,38 %), Asmet Salud (88,40 %) y Savia Salud (85,95 %) presentan cifras destacadas de ejecución. Sin embargo, algunas EPS apenas superan el mínimo exigido:
- Sanitas: 78,04 %
- Cajacopi: 78,50 %
- Nueva EPS: 78,14 %
Esto evidencia que, si bien hay cumplimiento formal, la ejecución real sigue muy cercana al umbral mínimo, lo que indica que muchas EPS están ajustando su comportamiento al mínimo requerido por norma, pero sin adoptar una mejora estructural en su modelo financiero.
Este seguimiento por parte de la ADRES es clave en el contexto actual del sistema, donde el giro directo se ha convertido en el principal mecanismo para garantizar la liquidez de hospitales y clínicas. El bajo cumplimiento por parte de EPS con alta concentración poblacional puede significar retrasos en la red de atención, judicialización del acceso a servicios y presión sobre la política pública.
Además, la persistencia del cumplimiento mínimo sin mejora estructural indica que muchas EPS están actuando por obligación normativa y no por voluntad de transformación operativa. Esto limita el impacto real del giro directo como mecanismo de sostenibilidad, especialmente si no se acompaña de incentivos positivos y sanciones efectivas.
Descargue aquí el boletín completo de la ADRES:
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