Entidades Promotoras de Salud: Everything you need to know

I have dealt with Entidades Promotoras de Salud (EPS) for many years. Like most Colombians, EPSs have played a central role in my life and that of my family. Whether you are just starting to navigate this system or have been enrolled in an EPS for years, it is crucial to understand what they are, how they work and, above all, how to maximize the benefits they offer.

The EPSare entities responsible for managing health services under Colombia's General Social Security Health System. Put simply: they are the bridge between the users (you, me, all Colombians) and the health service providers (the hospitals, clinics, doctors, etc.).

Main functions of the EPS

Broadly speaking, the mission of the EPS is to organize the provision of health services to affiliates, ensuring that the regulations in force are complied with. But this is not just about bureaucracy, there is much more.

1. Affiliation and administration: EPSs are responsible for affiliating citizens, either under the contributory scheme (workers who contribute) or the subsidized scheme (for people with no ability to pay). This includes workers, unemployed, pensioners and their families.
2. Guarantee access to health care: Once affiliated, the EPS connects you with doctors, hospitals and other services according to your plan. From a basic medical consultation to more complex treatments, everything goes through your EPS.
3. Prevention and promotion: It's not all about curing diseases. EPSs have programs aimed at preventing diseases through vaccination campaigns, medical check-ups, and health education programs.
4. Payment management: Although you may not see it, your EPS makes sure that payments to healthcare providers are made correctly and on time. Important for the system to work!

Types of EPS: Subsidized or Contributory?

Throughout my life, I have experienced both types of EPSs. On the one hand, the contributory scheme is for those who work and have the ability to pay, while the subsidized scheme is intended for those who do not have a formal job and, therefore, cannot afford to pay a monthly fee. The key difference? If you contribute, you can access more services and with fewer limitations, but if you don't, the state partially covers you.

Private, public and mixed EPS

The EPS in Colombia are divided into three main groups:

• Private: They are financed by companies and their coverage is more oriented towards the working class.
• Public: Here the funding comes from the state, and they are aimed at people with fewer resources.
• Mixed: They combine public and private funds, offering an intermediate option(.

My personal experience with EPS

I've already lost count of how many times I've had to deal with my EPS. It is not always an easy process. One encounters long waiting lists, delays in authorizing treatments, and once in a while, complaints about the quality of services provided. But over the years I have learned something key: you have to be your own advocate.

Tip #1: Know your rights. Did you know that EPSs are required by law to give you access to timely, quality care. If you feel that your EPS is not complying, you have the right to file a complaint with the National Health Superintendence.

Tip #2: Have your Mandatory Health Plan (POS) handy. Knowing what is covered and what is not will help you avoid unpleasant surprises. Most EPSs cover outpatient services, hospitalizations, emergencies, maternity and, in some cases, specialized services such as oncology care.

How to choose a good EPS

Not all EPSs are the same. Some practical tips for making a good decision:

• Geographic coverage: Not all EPSs have the same network of providers. Check that in your area of residence there are clinics and hospitals affiliated with your EPS.
• Quality of service: Ask friends and family about their experience. Some EPSs are known to offer better services in certain areas of health.
• Cost: In the contributory regime, the cost of the EPS varies according to your income. It is important to evaluate whether the cost of the fees is in line with the benefits you receive((.

Common problems and how to deal with them

One of the main challenges we face as users is the delay in care. It is common to hear complaints that authorizations for medical procedures take longer than they should. This is where the citizen ombudsmen and the National Superintendence of Health come into play, who ensure compliance with regulations.

Another problem is the saturation of the system. EPSs handle millions of users, which means that waiting lists, especially in the public sector, can be long. If you are in an emergency, don't hesitate to demand priority care!

The future of the EPS

In my opinion, the EPS system in Colombia needs profound reforms. Although they have been fundamental in guaranteeing access to healthcare, efficiency and transparency are areas for improvement. The good news is that more and more people are aware of their rights, which puts pressure on the system to be more efficient and fair.