'This is a healthcare model that has no turning back': Fomag

A year ago, the new healthcare model for Colombian teachers came into effect, the result of an agreement between Fecode and the government. The aim is to fundamentally transform a system widely criticized for its failures in care, delays, and fragmented services.

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Aldo Cadena, vice president of the National Fund for Teachers' Social Benefits (FOMAG), stated that a more accessible system, with greater oversight and a focus on quality, is already beginning to take shape. Cadena highlighted the achievements, but also acknowledged that there are still shortcomings.

They submitted their management results. How did they do? The first year of implementation of the model signed by Fecode and the government to transform the teacher healthcare system has passed. We went from 10 operators to just one, Fiduprevisora, with 2,400 contractors. Ten regional directorates were created, which didn't exist before; 33 departmental coordinators and 1,130 collaborators nationwide, exclusively with our own Fomag offices. We have 33 auditors, one for each department plus the capital district, to conduct concurrent audits, with quality oversight. During this phase, we also began recovering teachers' data and medical records, all of which were in the possession of the former operators. An occupational health and safety program, which didn't exist before, was launched, and we ordered the repeal of authorizations.

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In that part of the authorizations, were they 100% eliminated?

We still have authorizations in some services, because not everyone has heeded the guidance, but the order is to completely remove the authorizations.

Regarding payments to operators, how are things progressing? The payment situation for providers has improved. No provider exceeds 40 days of debt, except for occasional exceptions in specific cases, after submitting the invoice to the entity.

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The model has been criticized. What aspects do you think could be improved?

Speaking quite frankly, this is the best model that exists in the country, precisely because the service is territorialized. Furthermore, authorizations have been halted, teachers can choose their provider, and in many areas, the teaching profession has exclusive care. Something that wasn't previously available has increased: health promotion and prevention. Before, what we had was curative medicine, where business, corruption, and poor service quality prevail. However, there's still much room for improvement. We still have quite a few shortcomings. We're fine-tuning things with the unions, looking at where we're failing, making agreements with them, with the provider, with the supplier, and so on. The important thing is to reassure teachers that despite the difficulties that any new process presents in its implementation, we're making progress, optimizing, and we believe we're establishing solid foundations because this model has no turning back.

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What data do you have on the default rate?

The administrative noncompliance rate, which was 6.9, has been reduced to 6.3 in the four months I've been here. I recognize that we do have shortcomings today, but I also have to highlight the significant improvements.

Of all the crisis in the health system, how has it affected you? It's primarily affected us with medications. We're working at regional and local outposts to ensure teachers receive their medications. If they're not at the dispensing point, they're delivered to their homes. We still have to resolve that problem.

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What front are you working on?

We already have the software ready and upgraded for interoperability. This helps us so the teacher doesn't have to carry medical records under their arm. We've already run the tests and have it ready. In territorialization, we're preparing new contracts with the operators and a kind of dynamic tariff plan. The teacher can't be left without the service, which is why we've also strengthened this stage with more than 150 auditors to monitor the provision of quality services in each department and ensure that the service provided isn't abused. We're democratizing contracting. We're linking more public sectors because fortunately for the poor, at least, the State still operates in many municipalities. We're also contracting with them for primary care and prevention of breast, cervical, and prostate cancer. We're also working to detect diabetes, hypertension, and diseases that don't become critical early, thus saving lives and saving resources.

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Given the medication situation, what strategies are you implementing to mitigate the shortage?

We're precisely resolving this situation with the operators, working with those who are there, linking the teachers to the situation and to the audit itself. We had an important phenomenon at the beginning of this model: previously, the operators received a population of teachers, and for each one, they were paid a fee, whether they attended or not.

The business was not to dispense medications. When the new model came in, which took away that monopoly, there were more old providers who had their own networks. For us, it generated an avalanche of patients and immediately increased spending on medications, regardless of the number of prescriptions and services provided.

How are complaints going? The number of complaints filed during this phase has decreased, from 6.3 to 3.9 complaints per 1,000 users served. At this point, we can provide this information, which we consider quite positive, but there's still much room for improvement.

What's the trend in sick leave? Are teachers getting sick more often?

Yes, there are quite a few incapacities right now because we're receiving more care, and this is immediately reflected in the data. If we focus on prevention and promotion in the territorial context, we'll reduce this trend a little more. This year, we detected that 14,849 teachers traveled outside their campus. Forty-six percent were accompanied by someone, and 54% were alone; but some of these teachers traveled up to 40 times in search of care. When we talk about territorial context, we aim to ensure that teachers don't leave their campus. Now that we're moving forward, we see that the project is also reducing incapacity because we're serving people in a timely manner.

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How is resource management?

We're doing very well in terms of resources. For 2025, we're requesting the same budget as in 2024, not to stop providing services, but to improve management, save money, improve service, adjust rates, reduce travel, provide timely care, and increase outreach and prevention. This allows us to reduce expenses and the medical costs that are affecting rates, ensuring balanced use and even reducing the losses we may have had in the past. This year, we have a surplus of $341 billion, which allows us to improve the internal situation and reform it.

What plans do you have for the rest of the year?

We want to have a greater commitment to teachers to prevent losses and to increase primary care. This, with new elements being introduced to the occupational health and safety of teachers, primarily related to mental health, which is a global disease.

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