National Health Authority Republic of Colombia

1. National Health Authority Republic of Colombia

2. INSPECTION, SURVEILLANCE, AND CONTROL FUNCTIONS

3. AREA • Steering entity of the Health Inspection, Surveillance, and Control (ISC) System. • Sets inspection, surveillance, and control policiesto be followed by the essential public health service. • Exercises ISC in the exempted and special systems.

4. AREA • Coordinates user advocacy services. • Exercises legal authority over the services monitored and provides mediation. • Enforces application of the beneficiary selection criteria (SISBEN)

5. AREA • Enforces compliance with the principles and fundamentals of the essential public service of the social security health system. • Protects the rights of users - Right to insurance - Right of individuals and groups to health services.

6. AREA • Health service delivery without pressure from or the imposition of conditions by doctors. • Exercises authority over the services monitored in terms of ISC.

7. AREA • Ensures that EPS and IPS adopt the CODE OF CONDUCT AND GOOD GOVERNANCE that regulates the delivery of the services they provide • Authorizes the creation and accreditation of EPS

8. INSPECTION, SURVEILLANCE, AND CONTROL system

9. ISC SYSTEM Thematic Areas of the ISC System Efficiency, effectiveness, and efficacy inthe generation, flow, and administration of resources Financing Insurance Guarantee of members’ rights • Accessible individual and collective health services that adhere to quality standards • Health promotion and disease prevention • Diagnosis, treatment, and rehabilitation Service Delivery Ensure that the actors involved guarantee theproduction of transparent, quality data Information

10. ISC SYSTEM Thematic Areas of the ISC System Guarantee respect for users’ rights and actors’ fulfillment of their responsibilities and promote citizen participation Care for usersand social participation • Forcible administrative intervention to administer or close entities monitored • Technical and administrative intervention in territorial health bureaus • Oversight of voluntary closures • Closure after revocation of operating license Actions andspecial measures Targetingof health subsidies Application of criteria for determining, identifying, and selecting beneficiaries

11. DEFINITIONS FORTHE EXERCISE OF AUTHORITY by THE NHS

12. Inspection Warn, prevent,guide, assist, and encourage Surveillance Correct and sanction Control ISC SYSTEM Definitions Follow-up,monitoring, evaluation Ascertaining the situation with respect to the health services and their resources Determining compliance with standards in entities responsible for financing, insurance, and service delivery Order corrective measures for critical or irregular situations and sanction activities of entities monitored

13. Entities thatgenerate resources UNIVERSE OF ENTITIES MONITORED Special andExempted Systems ENTITIES MONITORED Contributory, Subsidized, Exempted, and Special Systems Public andPrivate IPS Public and private EPS Departmental andMunicipal Secretariats State-owned Social Enterprises Fosyga,Etesa,Idumil

14. Entities subject to Inspection, Surveillance, and Control

15. ORGANIZATION CHART

16. SUPERINTENDENCY FOR THE GENERATION AND MANAGEMENT OF FINANCIAL HEALTH RESOURCES

17. OBJECTIVE Guarantee the efficient generation, collection, flow, administration, custody, and use of resources for health service delivery.

18. SUPERINTENDENCY FOR HEALTH CARE

19. OBJECTIVE Perform inspection, surveillance, and control of the entities under its jurisdiction, ensuring compliance with the standards set for the management of health risk within the Social Security Health System.

20. INTERNAL STRUCTURE SUPERINTENDENCY FOR HEALTH CARE ADVISERS BUREAU FOR QUALITY AND HEALTH SERVICE DELIVERY INSURANCE BUREAU HEALTH RISK INSURANCE GROUP INSURER OPERATIONS GROUP HEALTH CARE GROUP PUBLIC HEALTH GROUP QUALITY IMPROVEMENT GROUP

21. SUPERINTENdency FOR user PROTECTION AND CITIZEN PaRTICIPAtion

22. POLICY OBJECTIVE Ensure respect for users’ rights in the SGSSS through inspection, surveillance, and control, and promote citizen participation and social control following the orientations provided in the participatory mechanisms established by law.

23. SUPERINTENDENCY FOR USERPROTECTION AND CITIZEN PARTICIPATION WORKING GROUPS:USER CARE GROUPCITIZEN PARTICIPATION GROUP INSPECTION AND SURVEILLANCE GROUPUSER ADVOCACY GROUP

24. SUPERINTENDENCY FOR SPECIAL MEASURES

25. Perform inspection, surveillance, and control of entities subject to corrective measures. 2. By order of the National Health Authority, take over and implement the respective interventions in the entities monitored to administer or close them. DECREE 1018 /07

26. DECREE 1018 /07 Take over Forcible intervention Administer Close Technical and administrative intervention Territorial entities

27. Superintendency for legal affairs and mediation

28. JUDICIAL AUTHORITY Hear and issue a definitive ruling, with the legal authority of a judge, on matters specified in the law; in addition, serve as a mediator in any disputes that arise among the entities monitored and/or between these and users that adversely affect the latter’s access to the health services.

29. Activities, Procedures, Interventions - POS 1. COVERAGE: Beneficiaries x emergency care 2. REFUNDS: Unjustified denial or negligenceof EPS Multiple coverage - Free Choice - Mobility--within the SGSSS CONFLICTS 3. NHS LEGAL FUNCTIONS Law 1122/07, Art. 41

30. (EPS, EPS-IPS, P.E.) • MONITORED ENTITIES MEDIATION IN NHS Law 1122/07, Art. 38 CONFLICTS THAT ARISE BETWEEN: • MONITORED ENTITIES AND USERS STEMMING FROM PROBLEMS THAT PREVENT THEM FROM MEETING THEIR OBLIGATIONS IN THE SGSSS, ADVERSELY AFFECTING USERS’ ACCESS TO THE HEALTH SERVICES.

32. POLICYOBJECTIVE

33. USER CARE GROUP

34. THANK YOU! Ana Milena Rizo arizo@supersalud.gov.co