EPS and IPS (insurers and providers)
- System and programme
The EPS is the insurer that enrols people and guarantees services; the IPS is the hospital, clinic or centre that treats the patient.
What it is
Health promoting entities (EPS) enrol and register people, manage their health risk and organise and guarantee the benefits plan, either directly or by contracting providers. Health service provider institutions (IPS) are the hospitals, clinics, centres and practices that deliver care, public, private or mixed. The EPS must offer its enrollees a network of IPS covering the different levels of complexity.
How it is organised
- EPS of the contributory scheme and EPS of the subsidised scheme; one EPS can operate in both.
- Public IPS (the State provides care directly through social enterprises of the State, Law 100, article 194), private and mixed.
- Point of entry: the primary provider (low complexity) in the enrollee's municipality.
- Referral and counter-referral: the patient moves up to higher complexity when needed and returns to primary care for follow-up.
Worked example
- A made-up 58-year-old man enrolled with an EPS visits his low-complexity IPS with chest pain on walking.
- The general practitioner refers him: the EPS assigns a medium-complexity IPS in its network for a cardiology assessment.
- Cardiac catheterisation is indicated and done at a high-complexity IPS contracted by the same EPS.
- After the procedure, counter-referral sends him back to his primary IPS for check-ups every 3 months.
EPS versus IPS
| Feature | EPS | IPS |
|---|---|---|
| Role | Insurer | Provider |
| What it does | Enrols, manages risk, contracts the network and guarantees the benefits plan | Treats: consultations, emergencies, admissions, surgery, diagnostics |
| Receives money from | The system, through ADRES (UPC) | The EPS, under the contract |
| Overseen by | National Health Superintendency | National Health Superintendency |
Markers
- EPS
- IPS
- ESE
- Provider network
- Referral and counter-referral
In practice
- Knowing the patient's EPS network speeds up referrals and avoids access barriers.
- In an emergency every patient is treated regardless of their EPS or whether a contract exists.
Reference norms
- Law 100 of 1993, articles 177 to 185 (EPS and IPS).
- Law 1122 of 2007, article 14: organisation of insurance.
- Law 1438 of 2011, articles 60 and 61: integrated health service networks.
- Decree 780 of 2016: free choice of and transfer between EPS.
Test yourself
Think of the answer, then tap the question to see it.
What separates an EPS from an IPS?
The EPS is the insurer that enrols people and guarantees services; the IPS is the provider that treats the patient.
What are integrated health service networks under Law 1438 of 2011?
The set of organisations that provide, or agree to provide, individual or collective services efficiently, equitably, comprehensively and continuously to a defined population.
Can an EPS pay an IPS by capitation?
Yes: Law 100 allows payment methods such as capitation, protocols or fixed global budgets, as well as fee-for-service.
What is counter-referral?
Sending the patient back from a higher level of complexity to the original provider, with instructions for follow-up.
Connections
Educational content on epidemiological and statistical methods; the examples use made-up numbers to teach the calculation. Not a clinical or legal guide: current Colombian rules are in the official sources.
Sources: Ley 100 de 1993 (Departamento Administrativo de la Función Pública, Colombia (Gestor Normativo), 1993); Ley 1438 de 2011 (Departamento Administrativo de la Función Pública, Colombia (Gestor Normativo), 2011); Ley 1122 de 2007 (Departamento Administrativo de la Función Pública, Colombia (Gestor Normativo), 2007).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.