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)

Abstract

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.