Impacto de las reformas y la crisis de las EPS en la sostenibilidad financiera de las IPS pequeñas en Colombia
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Fecha
2025
Autores
Bonadíez Cota, María Yaneth
De León Freyle, Bonibell Mishel
López Rangel, Maria Alejandra
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Ediciones Universidad Simón Bolívar
Facultad de Administración y Negocios
Facultad de Administración y Negocios
Resumen
El presente ensayo analiza el impacto de la crisis financiera de las entidades promotoras de salud (EPS) y la implementación del Decreto 858 de 2025 sobre la
sostenibilidad de las instituciones prestadoras de servicios de Salud (IPS) pequeñas en Colombia.
Mediante el análisis de datos de la ADRES y la Superintendencia Nacional de Salud, se examina cómo la deuda acumulada —superior a 32 billones de pesos— y la liquidación de aseguradoras generan un efecto cascada que compromete la liquidez de los prestadores con menor capacidad de respaldo.
El estudio profundiza en las paradojas del nuevo marco normativo: aunque el fortalecimiento del giro directo busca proteger a las IPS, la variabilidad mensual del flujo y las exigencias de interoperabilidad técnica imponen barreras administrativas que las
instituciones de baja complejidad difícilmente pueden costear.
Se concluye que, si bien el enfoque preventivo de la reforma ofrece oportunidades para el primer nivel de atención, la permanencia de las IPS pequeñas en zonas rurales depende de un acompañamiento estatal diferenciado y de mecanismos regulatorios que mitiguen la brecha operativa frente a los grandes prestadores, evitando así la consolidación de "desiertos asistenciales" y garantizando el derecho fundamental a la salud.
This essay analyzes the impact of the financial crisis of Health Promoting Entities (EPS) and the implementation of Decree 858 of 2025 on the sustainability of small Healthcare Service Provider Institutions (IPS) in Colombia. Through the analysis of data from ADRES and the National Superintendency of Health, it examines how the accumulated debt—exceeding 32 trillion pesos—and the liquidation of insurance companies generate a cascading effect that compromises the liquidity of providers with less financial backing. The study delves into the paradoxes of the new regulatory framework: although the strengthening of direct payments aims to protect IPS, the monthly variability of cash flow and the requirements for technical interoperability impose administrative barriers that lowcomplexity institutions can hardly afford. It is concluded that, while the preventive approach of the reform offers opportunities for primary care, the survival of small healthcare providers (IPS) in rural areas depends on differentiated state support and regulatory mechanisms that mitigate the operational gap with large providers, thus preventing the consolidation of "healthcare deserts" and guaranteeing the fundamental right to health.
This essay analyzes the impact of the financial crisis of Health Promoting Entities (EPS) and the implementation of Decree 858 of 2025 on the sustainability of small Healthcare Service Provider Institutions (IPS) in Colombia. Through the analysis of data from ADRES and the National Superintendency of Health, it examines how the accumulated debt—exceeding 32 trillion pesos—and the liquidation of insurance companies generate a cascading effect that compromises the liquidity of providers with less financial backing. The study delves into the paradoxes of the new regulatory framework: although the strengthening of direct payments aims to protect IPS, the monthly variability of cash flow and the requirements for technical interoperability impose administrative barriers that lowcomplexity institutions can hardly afford. It is concluded that, while the preventive approach of the reform offers opportunities for primary care, the survival of small healthcare providers (IPS) in rural areas depends on differentiated state support and regulatory mechanisms that mitigate the operational gap with large providers, thus preventing the consolidation of "healthcare deserts" and guaranteeing the fundamental right to health.
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Palabras clave
Sistema de salud colombiano, Intermediación, Reforma en salud, Sostenibilidad financiera, Equidad en salud