Mientras el país debate el futuro del sistema de salud, una de las voces más potentes que emerge es la del talento humano que lo sostiene. La audiencia pública realizada en el Senado de la República puso sobre la mesa las profundas fracturas laborales que afectan a médicos, enfermeras, técnicos y demás trabajadores del sector.
La discusión sobre el Proyecto de Ley 410 de 2025, reforma a la salud 2.0, no solo reveló la precariedad de sus condiciones contractuales, sino también la falta de garantías claras sobre la financiación de la reforma y la exclusión de actores clave en su diseño. La urgencia de transformar la salud en Colombia se enfrenta a una pregunta esencial: ¿cómo construir un nuevo modelo sin dignificar a quienes lo hacen posible?
La precarización laboral: un fenómeno persistente
Uno de los ejes centrales de la audiencia fue la crítica generalizada al modelo actual de contratación en el sistema de salud. Diversos intervinientes señalaron la persistencia de la tercerización laboral, la generalización de contratos de prestación de servicios para funciones permanentes y los retrasos en los pagos como factores que han deteriorado la estabilidad emocional y profesional del personal de salud.
“Los retrasos en los pagos, el deterioro salarial constante y también el estancamiento en las remuneraciones han desvalorizado la invaluable función que cumplen los profesionales del sector”, expresó uno de los participantes. Según un estudio citado de Acuerdos Fundamentales, entre 2023 y 2024, el 59% de los trabajadores reportaron mejoras en la oportunidad de pago, pero entre el 30% y el 80% afirmaron que la situación ha afectado negativamente su salud mental.
Llamados a un régimen laboral especial
El consenso entre los participantes es que el país requiere con urgencia un régimen laboral especial para el sector salud que contemple condiciones dignas y estables, y que reconozca la especificidad del trabajo en este ámbito. Algunas propuestas incluyen la creación de una carrera administrativa en salud o la modificación del Código Sustantivo del Trabajo con un capítulo exclusivo para este sector.
Varios gremios sugirieron que el cumplimiento de las garantías laborales sea un criterio habilitante para las Instituciones Prestadoras de Servicios de Salud (IPS). Asimismo, se propuso establecer una subcuenta de garantías dentro del sistema para proteger a los trabajadores en caso de falta de pago.
Un punto que generó debate semántico y político fue el uso del término “talento humano”, considerado por líderes sindicales como una forma de desdibujar la realidad laboral. Jessid Hernando Camacho y Hernán Bayona, entre otros, abogaron por hablar de “trabajadores de la salud” para enfatizar la relación laboral y no solo la función técnica.
La financiación de la reforma, aún sin certezas
Otro aspecto ampliamente debatido fue la sostenibilidad financiera de la reforma. Senadores y voceros gremiales criticaron la ausencia reiterada del Ministro de Hacienda y del Ministro de Salud en los debates, así como la falta de un aval fiscal claro que respalde los cambios estructurales propuestos.
Se estimó que la formalización del personal de salud podría requerir hasta 9 billones de pesos, y aún no se ha especificado de dónde saldrán estos recursos. “Para eso no se necesita ley de la República, se necesita plata, y eso es lo que no hay”, sostuvo el Dr. Esteban Bustamante, de la Federación Odontológica Colombiana.
El Ministerio de Hacienda anunció que su concepto técnico sobre el proyecto está en proceso de redacción y se espera su radicación en los próximos días. Paralelamente, el Viceministro de Salud informó que en la plenaria de la Cámara se incluyeron nuevas fuentes de financiación y mecanismos para el saneamiento de deudas, que permitirían pagar directamente a prestadores y personal de salud.
Participación de gremios y rol de la academia
Sociedades científicas, colegios profesionales y voceros académicos manifestaron su inconformidad con la falta de participación real en la elaboración del articulado. La Asociación Colombiana de Sociedades Científicas solicitó una representación nominal en el Consejo Nacional de Salud, alegando que agruparlas con otras organizaciones diluye su rol técnico.
“La salud de Colombia no es de derecha ni de izquierda; es del país”, enfatizó la senadora Berenice Doyá, haciendo eco de los llamados a garantizar la participación de expertos en la toma de decisiones sobre regulación, formación de profesionales y convalidación de títulos.
La Federación Odontológica y otros gremios también señalaron que el Ministerio de Educación no puede ser el único actor regulador de las especialidades. Se pidió mayor protagonismo de las sociedades científicas en procesos de docencia-servicio, regulación y validación técnica.
Análisis del articulado: artículos clave en debate
Varios artículos del Proyecto de Ley 410 fueron objeto de observaciones puntuales:
- Artículo 37: se pidió eliminar el párrafo que reduce la intervención de médicos especialistas en servicios especializados.
- Artículo 45: se solicitó que incluya a todas las disciplinas del área de la salud y garantice condiciones de formación para todas las regiones.
- Artículo 47 y 48: se valoró la intención de formalizar el empleo, pero se pidió que el régimen especial defina escalas salariales mínimas y vinculación directa. Hubo preocupación por las facultades extraordinarias para regular el régimen privado, percibidas como riesgosas por su potencial opacidad.
- Artículo 49 y 50: se advirtió sobre la posibilidad de que, al citar el Código Sustantivo del Trabajo, se perpetúen las formas de contratación actuales (OPS), en contradicción con la intención de reforma.
- Artículos 51 y 52: la Superintendencia Nacional de Salud propuso ampliar sus funciones para sancionar a instituciones que incumplan condiciones laborales básicas.
Atención primaria y especialidad en medicina familiar
La audiencia también abordó la importancia de fortalecer la Atención Primaria en Salud (APS) como eje del nuevo sistema. Aunque se reconoce su centralidad, varios participantes denunciaron que actualmente existen médicos familiares capacitados pero desempleados, lo cual pone en duda el compromiso estructural con esta especialidad.
La propuesta de convalidaciones exprés en 30 días fue duramente cuestionada. Se argumentó que el problema no es la duración del trámite, sino la ausencia de criterios técnicos y de participación de profesionales del área en las decisiones. Se pidió restablecer comités técnicos por disciplina y reforzar la autonomía profesional.
El rol del ADRES en el nuevo modelo
Durante la audiencia, el director encargado del ADRES explicó que la entidad tiene capacidad técnica y operativa para pagar directamente la nómina del personal de salud, como ya ocurrió durante la pandemia. Indicó que mensualmente se giran 7.3 billones de pesos por UPC a las EPS, aunque advirtió que los recursos se concentran en un número reducido de IPS y proveedores.
A pesar de los múltiples cuestionamientos, la mayoría de los intervinientes coincidió en que la reforma al sistema de salud es necesaria. “Si no hay reforma, no se garantiza el derecho a la salud, porque este derecho se ha convertido en un negocio y no en un derecho”, afirmó Cecilia Vargas, de SINDES.
Los senadores participantes reconocieron la profundidad de las preocupaciones y reiteraron su compromiso con un diálogo técnico, abierto y participativo. Para ello, anunciaron una mesa técnica sobre financiación para el próximo 13 de mayo, además de nuevas audiencias públicas en Huila, Bucaramanga y Risaralda.
El debate continúa.
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