Under the proposed legal framework, the direct transfer of funds from the ADRES (Administrator of the Resources of the General System of Social Security in Health) to healthcare providers and technology suppliers will increase to a minimum of 90%. This strict financial requirement applies to the Capitation Payment Units (UPC) of both the contributory and subsidized regimes.
From a compliance perspective, the 90% minimum threshold will be legally enforced upon Health Maintenance Organizations (HMO) that fail to meet their adequate equity requirements, those subjected to special surveillance, administrative intervention, or liquidation, and those that voluntarily opt into the mechanism. Furthermore, this legal mandate is extended to the “maximum budgets” (presupuestos máximos), ensuring that at least 90% of the funds allocated for specialized services and technologies not covered by the standard UPC are also transferred directly to the medical providers.
This draft decree addresses critical systemic failures highlighted by the Constitutional Court regarding the liquidity and flow of health resources. The regulatory authority identified that persistent payment uncertainty has directly caused the closure of medical services and the incomplete delivery of medications to patients. By implementing this rigorous financial reform, the state intends to promote institutional transparency, prevent resource misappropriation, and legally protect the fundamental right to health.
The draft decree is currently open for public consultation, allowing citizens and stakeholders to submit their formal observations between May 20 and May 27, 2026.
