Incidencia de la gestión de facturación hospitalaria en la sostenibilidad financiera y la calidad del servicio: caso Unidad Hospitalaria Castilla – ESE Metrosalud en la Ciudad de Medellín (junio -diciembre 2024)
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Este estudio de caso analiza la gestión de la facturación hospitalaria en la Unidad Hospitalaria Castilla de la ESE Metrosalud, durante el periodo junio a diciembre de 2024, y su incidencia en la sostenibilidad financiera y la calidad de la prestación del servicio de salud. Mediante un enfoque descriptivo que combina análisis cuantitativo con la percepción del personal administrativo y asistencial. Se identificaron deficiencias en la oportunidad de radicación de facturas, una alta proporción de glosas y devoluciones, y limitaciones en la articulación entre las áreas clínicas y administrativas. Los resultados evidencian que solo el 34,66 % de las facturas fueron radicadas en el mismo mes de prestación del servicio, mientras que el 99,21 % del valor glosado permanecía pendiente de respuesta al finalizar el periodo, lo que refleja un riesgo elevado de no recaudo. Asimismo, se evidenció una alta dependencia del régimen subsidiado, tanto en volumen como en valor facturado, lo que representa un riesgo estructural para la estabilidad financiera institucional. Los hallazgos confirman que una gestión deficiente de la facturación incrementa las glosas y devoluciones, afectando directamente la recuperación de ingresos y, en consecuencia, la sostenibilidad financiera del hospital. A partir de estos resultados, se plantea una propuesta de mejora orientada a la optimización de flujos de trabajo, el fortalecimiento del talento humano y la implementación de mecanismos de trazabilidad institucional, con el fin de mejorar la eficiencia, aumentar la recuperación de ingresos y robustecer la gobernanza hospitalaria.
This case study analyzes the management of hospital billing at the Castilla Hospital Unit of ESE Metrosalud during the June–December 2024 period, and its impact on financial sustainability and the quality of healthcare service delivery. A descriptive approach was applied, combining quantitative analysis with the perceptions of administrative and clinical staff. The study identified shortcomings in the timeliness of invoice submission, a high proportion of claim adjustments and returns, and limited coordination between clinical and administrative areas. Results show that only 39.9% of invoices were submitted in the same month in which services were delivered, while 99.2% of the disputed amount remained pending response by the end of the period, indicating a high risk of non-collection. In addition, a strong reliance on the subsidized insurance regime was observed in both volume and billed value, representing a structural risk to the institution’s financial stability. These findings confirm that inadequate billing management increases adjustments and returns, directly undermining revenue recovery and, consequently, the hospital’s financial sustainability. Based on the results, an improvement proposal is presented focused on optimizing workflows, strengthening human talent, and implementing institutional traceability mechanisms to enhance efficiency, increase revenue recovery, and reinforce hospital governance.
This case study analyzes the management of hospital billing at the Castilla Hospital Unit of ESE Metrosalud during the June–December 2024 period, and its impact on financial sustainability and the quality of healthcare service delivery. A descriptive approach was applied, combining quantitative analysis with the perceptions of administrative and clinical staff. The study identified shortcomings in the timeliness of invoice submission, a high proportion of claim adjustments and returns, and limited coordination between clinical and administrative areas. Results show that only 39.9% of invoices were submitted in the same month in which services were delivered, while 99.2% of the disputed amount remained pending response by the end of the period, indicating a high risk of non-collection. In addition, a strong reliance on the subsidized insurance regime was observed in both volume and billed value, representing a structural risk to the institution’s financial stability. These findings confirm that inadequate billing management increases adjustments and returns, directly undermining revenue recovery and, consequently, the hospital’s financial sustainability. Based on the results, an improvement proposal is presented focused on optimizing workflows, strengthening human talent, and implementing institutional traceability mechanisms to enhance efficiency, increase revenue recovery, and reinforce hospital governance.
Palabras clave
Facturación hospitalaria, Glosas médicas, Sostenibilidad financiera, Calidad en la prestación de servicios de salud, Gestión pública hospitalaria, ESE Metrosalud, Estudio de caso, Hospital billing, Medical claim adjustments (glosas), Financial sustainability, Quality of healthcare service delivery, Public hospital management, ESE Metrosalud, Case study