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Minsalud interpela a la Corte sobre el reajuste de la UPC y advierte riesgos por ambigüedades en la medida
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El Ministerio de Salud y Protección Social (Minsalud) ha elevado 14 inquietudes y más de 50 preguntas a la Sala Especial de Seguimiento de la Corte Constitucional, en relación con el reciente auto 007 de 2025, el cual declaró la insuficiencia general de la Unidad de Pago por Capitación (UPC) para 2024 y ordenó su reajuste para 2025 y los años siguientes. Estas solicitudes surgen tras considerar que algunas determinaciones de la Corte presentan ambigüedades y podrían afectar la operatividad del sistema de salud en Colombia.
El documento presentado por el Ministerio expone que la decisión de la Corte de declarar insuficiente la UPC de 2024 se basó en afirmaciones de agremiaciones de EPS y de las propias entidades promotoras de salud, sin contar con estudios técnicos imparciales que respalden la existencia de un rezago financiero. Según Minsalud, la Sala Especial de Seguimiento no presentó un análisis detallado que justificara esta insuficiencia ni el porcentaje específico de incremento que garantizaría la sostenibilidad del sistema.
Las inquietudes de Minsalud: Falta de sustento técnico y ambigüedades en la decisión
El documento presentado por el Ministerio expone más de 50 preguntas y 14 inquietudes dirigidas a la Corte Constitucional. Entre los principales cuestionamientos se encuentran:
1. Falta de estudios técnicos imparciales
Minsalud argumenta que la decisión de la Corte se basó en afirmaciones de EPS y sus agremiaciones, sin que se haya realizado un análisis técnico independiente que respalde la existencia de un déficit estructural. Además, señala que la Sala Especial de Seguimiento de la Corte no presentó un estudio que justificara de manera clara la insuficiencia de la UPC y el porcentaje de incremento que debería aplicarse.
2. Incongruencias en la orden de reajuste retroactivo
Otro punto que genera preocupación es la orden de la Corte de realizar ajustes retroactivos en la UPC desde 2021. Según Minsalud, la insuficiencia fue declarada para la vigencia 2024, por lo que no existe un sustento jurídico o técnico para extender el ajuste a años anteriores. Además, esta medida podría comprometer seriamente los recursos financieros del sistema y generar un impacto negativo en la planeación presupuestal.
3. Implicaciones sobre la autonomía del Ministerio de Salud
El Ministerio advierte que la orden de la Corte podría estar extralimitando sus funciones, ya que la fijación y ajuste de la UPC es una competencia exclusiva del Gobierno Nacional, conforme a la normatividad vigente. La Corte, al ordenar un reajuste sin estudios técnicos imparciales y al modificar de facto el sistema de cálculo de la UPC, podría estar interviniendo en decisiones que corresponden al Ejecutivo.
4. Problemas en la implementación de la Mesa Técnica de Seguimiento
La Corte también ordenó la creación de una Mesa Técnica de Seguimiento con la participación de diversas entidades como el Ministerio de Hacienda, la ADRES, organismos de control, EPS, IPS, agremiaciones del sector, asociaciones de pacientes y representantes académicos. Sin embargo, Minsalud ha planteado preocupaciones sobre la falta de claridad en la estructura y funcionamiento de esta mesa, cuestionando aspectos como:
- ¿Quién la presidirá?
- ¿Cómo se tomarán las decisiones y con qué nivel de obligatoriedad?
- ¿Cuáles serán los criterios de participación y representación de los actores involucrados?
Estas ambigüedades podrían generar dificultades en la implementación de las decisiones y afectar la gobernanza del sistema de salud.
5. Impacto del ajuste ex post y riesgo de desestabilización financiera
Uno de los puntos más sensibles es la directriz de la Corte de establecer un mecanismo de ajuste ex post de la UPC, basado en el Índice de Precios al Consumidor (IPC) definitivo. Minsalud advierte que esta medida podría generar problemas de sincronización contable y presupuestal, ya que la UPC funciona bajo un esquema de financiamiento anticipado y de gestión del riesgo. La posibilidad de ajustes posteriores podría desincentivar la eficiencia en el uso de los recursos y generar incertidumbre en la planeación financiera del sistema.
Adicionalmente, el Ministerio cuestiona si el reajuste se aplicará de forma retroactiva, lo que implicaría la realización de pagos adicionales a las EPS en los próximos años, con un impacto significativo en el presupuesto de salud.
El llamado del Ministerio de Salud a la Corte Constitucional se produce en un contexto en el que la sostenibilidad financiera del sistema de salud colombiano ha sido objeto de amplio debate. Tanto el Gobierno Nacional como las EPS han expresado preocupaciones sobre la suficiencia de los recursos, especialmente ante los crecientes costos de la atención en salud, la incorporación de nuevas tecnologías y el aumento de enfermedades crónicas.
La falta de claridad en la suficiencia de la UPC y los ajustes impuestos por la Corte podrían generar incertidumbre y conflictos entre los diferentes actores del sistema. De ahí que Minsalud insista en la necesidad de contar con estudios técnicos que respalden cualquier decisión de ajuste y en la importancia de garantizar que los procesos de financiamiento se mantengan dentro del marco normativo vigente.
Decisión de la Corte sobre la UPC podría generar conflictos en el sector salud, advierte Minsalud
El documento enviado a la Corte enfatiza que algunas de las órdenes y lineamientos de la sentencia “podrían afectar la operatividad del sector salud y generar conflictos jurídicos e institucionales”. Por ello, el Ministerio ha solicitado claridad sobre los alcances de estas medidas y sus implicaciones financieras.
Este debate sobre la UPC se da en un contexto de presión financiera para el sistema de salud, en el que tanto el Gobierno como las EPS han expresado preocupaciones sobre la suficiencia de los recursos y el impacto de los ajustes en la sostenibilidad del modelo de aseguramiento.
En los próximos días, se espera que la Corte Constitucional responda a los cuestionamientos del Ministerio de Salud y precise los alcances de su decisión, con el fin de garantizar claridad en la aplicación de las medidas y la estabilidad del financiamiento del sistema de salud colombiano.
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