Unequal Paths to Efficiency: EPS vs. IPS Resource Use in Colombia’s Caribbean Health System
Author(s)
JUAN C. FERNANDEZ MERCADO, MBA, MSc, PhD, MD1, Nelson Alvis-Guzman, MPH, PhD, MD2.
1UNIVERSIDAD DE CARTAGENA, Cartagena, Colombia, 2Universidad de Cartagena - ALZAK Foundation, Cartagena, Colombia.
1UNIVERSIDAD DE CARTAGENA, Cartagena, Colombia, 2Universidad de Cartagena - ALZAK Foundation, Cartagena, Colombia.
OBJECTIVES: To examine the disparities in resource management strategies between Health Promotion Entities (EPS) and Health Service Providers (IPS) within Colombia’s Caribbean region. This study identifies systemic inefficiencies, institutional asymmetries, and patterns of waste that undermine the pursuit of financial sustainability and equity in health service delivery.
METHODS: A comparative case study design was employed, combining document analysis, key informant interviews (n=22), and policy review from EPS and IPS operating in Bolívar, Córdoba, and Sucre. Thematic analysis was conducted on five operational domains: contracting, risk-sharing, payment timing, care delivery autonomy, and cost-tracking practices. Cost deviation indicators were modeled using simulated microcosting for chronic care pathways in diabetes, renal disease, and oncology.
RESULTS: The study revealed divergent operational logics between EPS and IPS. EPS prioritized budget containment and administrative control, while IPS faced underfunded service packages and misaligned payment schedules. 67% of IPS surveyed lacked structured cost-tracking systems. Miscommunication and fragmented governance led to duplications in service delivery and delays in patient care. Estimated resource waste in the region surpassed COP $1.2 trillion annually. The absence of integrated costing frameworks and contractual alignment contributes to this inefficiency. Proposed reforms include outcome-based modular contracts, standardization of care bundles, and implementation of real-time costing tools.
CONCLUSIONS: Colombia’s Caribbean health system is marked by institutional asymmetry and operational inefficiency. EPS and IPS follow unequal paths to efficiency, often reinforcing fragmentation. Bridging this gap requires governance innovations and the incorporation of microeconomic tools to align incentives, improve resource flow, and elevate care quality. Implementing value-based contracting and cross-sector costing models could transform the region into a benchmark for integrated, efficient healthcare.
METHODS: A comparative case study design was employed, combining document analysis, key informant interviews (n=22), and policy review from EPS and IPS operating in Bolívar, Córdoba, and Sucre. Thematic analysis was conducted on five operational domains: contracting, risk-sharing, payment timing, care delivery autonomy, and cost-tracking practices. Cost deviation indicators were modeled using simulated microcosting for chronic care pathways in diabetes, renal disease, and oncology.
RESULTS: The study revealed divergent operational logics between EPS and IPS. EPS prioritized budget containment and administrative control, while IPS faced underfunded service packages and misaligned payment schedules. 67% of IPS surveyed lacked structured cost-tracking systems. Miscommunication and fragmented governance led to duplications in service delivery and delays in patient care. Estimated resource waste in the region surpassed COP $1.2 trillion annually. The absence of integrated costing frameworks and contractual alignment contributes to this inefficiency. Proposed reforms include outcome-based modular contracts, standardization of care bundles, and implementation of real-time costing tools.
CONCLUSIONS: Colombia’s Caribbean health system is marked by institutional asymmetry and operational inefficiency. EPS and IPS follow unequal paths to efficiency, often reinforcing fragmentation. Bridging this gap requires governance innovations and the incorporation of microeconomic tools to align incentives, improve resource flow, and elevate care quality. Implementing value-based contracting and cross-sector costing models could transform the region into a benchmark for integrated, efficient healthcare.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
OP26
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Organizational Practices
Topic Subcategory
Academic & Educational
Disease
No Additional Disease & Conditions/Specialized Treatment Areas