Social health protection (SHP) has a long history in Colombia. The Sistema General de Seguridad Social en Salud (SGSSS) (the national social welfare fund), established in 1915, provided health care for public sector employees. It was followed by Instituto Colombiano de Seguros Sociales (the social insurance institute), which offered coverage to private sector employees starting in 1946. The national health system began state financed, public assistance in 1970, covering the general population.
The 1991 Political Constitution of Colombia established health care as a public service provided by the state (Article 49).
Law 100 of 1993 aims to achieve universal insurance coverage through a solidarity-based insurance scheme, and although under state direction, management is delegated to health promotion entities [entidades promotoras de salud] (EPSs). EPSs manage health and financial risks and contract care with health service provider institutions [instituciones prestadoras de servicios] (IPSs).
Public spending and social health protection
The administrator of health resources collects resources and pays EPSs by the Capitation Payment Unit, funded by employees, employers and public budget.
In 2021, domestic general government health expenditure (GGHE-D) represented 6.55% of GDP (one of the few countries in the region to surpass the 6% recommended by the Pan American Health Organization). GGHE-D was 19% of general government expenditure, demonstrating state commitment to health care. Out-of-pocket (OOP) expenditure was 13.7% of current health expenditure in 2021, one of the lowest in the region.[1]
SHP in Colombia covers 49.6 million people (47.3% under the contributory regime and 52.7% under the subsidized regime), of whom 2.2 million belong to the special or exceptional regime. The UHC Service Coverage Index is 79.6.[2]
Main challenges
Colombia has made progress over the last three decades, achieving greater public financing, reduction in OOP expenditure and exceptional subscription to the national mechanism, leading to better access and improved health indicators.[3] However, challenges and financial pressures remain, in part due to an aging population, increased demand for services and rising costs, particularly for medicines. It is estimated that the deficit could reach 2.8% of GDP in 20 years (by about 2042), underscoring the need to optimize resource use.[4]
The Ministry of Health and Social Protection of Colombia has a national strategy to address the reduction of persistent health inequalities, combining policy reform, increased funding, innovative care delivery models and community engagement. Promoting equity in access to health care services is crucial, as is increasing resources for primary health care. Efficient use of available resources and increased productivity could contribute to responding to these challenges.
References
[1] World Health Organization, Global Health Expenditure Database, Health Expenditure Profile (choose country)
[2] World Health Organization, Health Financing and Economics, WHO Health Financing Dashboard (choose country)
[3] World Bank Group, PHCPI Primary Health Care Vital Signs Profile Assessment for Colombia
[4] Jairo H. Restrepo, Carlos Agudelo, Enrique Peñaloza, Juan Carlos García-Ubaque, Natalia Arias, Óscar Bernal, Apuntes de Gestión y Políticas Públicas, Universidad de los Andes, Escuela de Gobierno Alberto Lleras Camargo
