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¿EPS en crisis? Patrimonio negativo histórico y deudas que superan en 64% los activos: Así Vamos en Salud
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El sistema de aseguramiento en salud en Colombia enfrenta un deterioro estructural sin precedentes. Según el informe “Análisis financiero de las EPS en Colombia: primer semestre de 2019 a 2025”, elaborado por el centro de pensamiento Así Vamos en Salud, las Entidades Promotoras de Salud (EPS) muestran un panorama crítico: el patrimonio negativo se multiplicó por 20 en tres años, las deudas superan en un 64% los activos y las pérdidas operacionales alcanzaron los -$2,4 billones en 2025.
Patrimonio negativo: una señal crítica de insolvencia
El estudio, basado en cifras oficiales de la Superintendencia Nacional de Salud, revela que al cierre del primer semestre de 2025 las 23 EPS que reportaron información presentan un nivel de insolvencia técnica que pone en riesgo la sostenibilidad del sistema y la atención de millones de afiliados.
El patrimonio, que en 2022 registraba un saldo negativo de -$550 mil millones, alcanzó en 2025 los -$11,4 billones, es decir, un incremento de más de 20 veces. A ello se suma un desequilibrio patrimonial profundo: los pasivos se ubican en $29,6 billones, frente a activos de apenas $18,1 billones, lo que genera una relación pasivo/activo del 164%.
Este nivel de endeudamiento ratifica que las EPS se encuentran en situación de insolvencia técnica, sin capacidad financiera para cubrir sus compromisos con prestadores de servicios de salud ni garantizar un flujo de recursos estable.
Resultados operacionales en rojo
El informe advierte que el desbalance financiero de las EPS no es coyuntural, sino estructural. En 2025 las pérdidas operacionales llegaron a -$2,4 billones, debido a que los ingresos por concepto de Unidad de Pago por Capitación (UPC), estimados en $36,1 billones, no alcanzaron para cubrir los egresos: $36 billones en costos de salud y $2,5 billones en gastos administrativos.
La siniestralidad, relación entre lo gastado y lo recibido, superó el 100% de forma sostenida en el periodo 2022-2025, alcanzando entre el 101% y el 104%. Este indicador refleja que, por cada peso recibido, las EPS destinaron más recursos de los que ingresaron, lo que profundiza la insostenibilidad del modelo.
Concentración del riesgo en algunas EPS
Uno de los hallazgos más relevantes del análisis es la alta concentración de riesgo financiero. Siete EPS concentran el 80% de los activos y el 74% de los pasivos, lo que significa que la viabilidad del sistema depende en gran medida de la estabilidad de estas entidades.
Esta situación es crítica si se considera que más de 26 millones de colombianos dependen de su funcionamiento. Cualquier dificultad en su operación impacta directamente la continuidad y oportunidad de la atención en salud de la población afiliada.
El caso de la Nueva EPS: un vacío en la información
Un punto especialmente alarmante del informe es la ausencia de información financiera de la Nueva EPS desde 2024, a pesar de ser la entidad con mayor número de afiliados en el país (24%).
En su último reporte de 2023, la entidad registró activos por $6 billones. Sin embargo, la falta de datos actualizados impide conocer la magnitud real de su situación. Según Así Vamos en Salud, de confirmarse un deterioro similar al del resto del sector, el impacto sobre el sistema sería aún mayor, dado el peso de esta EPS en la cobertura nacional.
Factores estructurales de la crisis
El informe identifica varios elementos que explican la crisis de sostenibilidad de las EPS:
- Ingresos insuficientes: la UPC no cubre el costo real del plan de beneficios en salud.
- Liquidez frágil: gran parte de los recursos depende de cuentas por cobrar difíciles de recuperar.
- EPS intervenidas sin mejora: a pesar de medidas de control, siguen reportando déficits crecientes.
Estos factores, sumados a la inflación en costos médicos, el aumento de tecnologías y la presión sobre el gasto en salud, conforman un escenario que compromete tanto a las aseguradoras como a los prestadores.
Llamado a decisiones inmediatas
Así Vamos en Salud advierte que la crisis requiere medidas inmediatas y estructurales. El centro de pensamiento plantea tres acciones urgentes:
- Revisar y ajustar la UPC para que cubra efectivamente el costo del plan de beneficios en salud.
- Garantizar liquidez inmediata a los prestadores, con el fin de proteger la atención de los pacientes.
- Exigir transparencia financiera total a las EPS, en especial a la Nueva EPS, cuya falta de reporte impide una lectura real del panorama.
El informe concluye que la sostenibilidad del sistema y el derecho a la salud de millones de colombianos dependen de decisiones firmes y oportunas que aseguren el flujo de recursos, la cobertura universal y la estabilidad financiera del aseguramiento en salud.
Consulte el “Análisis financiero de las EPS en Colombia: primer semestre de 2019 a 2025”, aquí:
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