Colombia's health system is a complex cluster of different types of service delivery. It is known as a “mixed system”, due to the fact that there is a public and a private system to be able to serve the population.
The public health system in Colombia is managed by the government and is known as General Social Security System in Health (SGSSS). This system is funded through mandatory contributions from employers, employees, and the government. The SGSSS offers universal health coverage for all Colombian citizens and legal residents, guaranteeing access to basic health services.
Embedded in the SGSSS are different entities, including:
- Health Promotion Companies (EPS) — are responsible for organization and Financing of services of health. EPS can be public and private companies. However, the financing of public companies goes to the subsidized regime, while private companies fund the contributory scheme (through the monthly payment paid by the registrants).
- Health Service Provider Institutions (IPS) — are responsible for direct provision of services of health;
- Professional Risk Management (ARP) — which takes care of accidents at work and occupational diseases.
In addition to the public system, Colombia also has a private health system, which is used by those who can pay for additional health services or opt for more exclusive care.
Origin of the health system
The history of the health system in Colombia went through several phases until it finally achieved this model. See which stages marked this evolution:
Pre-Twentieth Century — Before the 20th century, health care in Colombia was generally private and dispersed. This was because, at that time, there were few institutions dedicated to medical care, in addition to many being operated by religious or charitable groups. Consequently, the majority of the population, and especially residents of rural areas, had little or no access to modern medical services.
Early Twentieth Century — At the beginning of the 20th century, due to urbanization and economic development, hospitals and clinics began to appear little by little. In addition, the State became more active in public health, establishing the first legislation to regulate medical practice and other health-related professions.
The 1940s — And then, a truly disruptive moment begins: in 1946, the Social Security Institute (ISS) was created.
The purpose of this new entity was an attempt to implement a health model based on the European example - specifically the system Bismarckiano of Germany, which in practice meant making social insurance mandatory, offering universal coverage, having a decentralized administration, and supporting itself with the help of public-private funding.
In addition, the ISS made it a priority to provide health insurance for formal workers. In other words, despite significant progress, this model still excluded a large part of the informal and rural population.
Year 1993 — The true transformation of the Colombian health system took place in 1993, when Law 100 was passed and culminated in the creation of General Social Security System in Health (SGSSS).
The purpose of the new law was finally aimed at universalizing access to health. Thus, a system based on two regimes was established: contributory And the subsidized.
In the contributory part, workers must pay for insurance. At the same time, in the subsidized sector, the government offers tax incentives to finance access to health for unemployed and low-income people.
How it works
Colombia's health system is categorized as mixed and decentralized, and is comprised of two regimes:
- Subsidized Regime (RS), responsible for serving about 40% of the population, especially those with low incomes. In addition, the government uses public resources to pay the SGSSS, fulfilling the role of those who are unable to pay.
Regarding the service, in Rio Grande do Sul, more basic procedures stand out, such as primary care, maternity care, and others.
To access the institutions of this regime, it is necessary to register with one of the subsidized Health Promoting Entities (EPS).
In addition, embedded in RS there are also the Pay-per-Capper Units (UPCs), being the fixed amounts associated with each citizen enrolled in the subsidized regime. To arrive at a specific number, factors such as: inflation index, availability of resources, and what are the main needs of the population are taken into account.
After determining the amount, the State allocates the amount to finance the services. The payment goes to the subsidized EPS and is then passed on to the service providers. The money collected by the UPCs comes mainly from the collection of taxes and other contributions made by entities.
- Contribution Regime (RC) — On this side of the regime, things work quite differently.
Supported by the fees paid by workers and employers, the offer of services is more complete when compared to Rio Grande do Sul. No contributory, patients have easy access with specialists and complex procedures. But before all this, each citizen must contribute to the EPS and pay a monthly fee.
Regarding the payment method, the possibilities vary according to the worker's situation. It is possible to pay through a payroll discount for formal workers; or to pay directly to EPS, when they are self-employed; and there is also funding by the State for indirect beneficiaries - who consist of retirees, pensioners and people with disabilities.
Current Discussion
Until the arrival of the Covid-19 pandemic, RC and RS were working reasonably well. However, with the overload on the system during the health crisis, the problems worsened. Thus, everything led the country to arrive at the great discussion of 2024: the Colombian health system must undergo a reform.
Among the main demands are issues associated with decentralization and governance; sustainable finance; corruption and bureaucracy; efficiency; expanding coverage and access; and innovation and technology.
With regard to decentralization, some argue that the current strongly centralized structure impedes efficiency and local responsiveness to health needs. They propose that regions and municipalities have more autonomy to implement and manage health services.
Another concern of Colombians is regarding financial sustainability of the health system. Funding is currently seen as insufficient. As a solution, some believe that the solution would be to carry out fiscal reforms, so that products harmful to health would be taxed more than others - such as alcohol and tobacco. In addition, reevaluating the resource allocation structure for EPS is also seen as a necessary action to become sustainable.
Regarding health coverage, some argue that the reform should seek not only to maintain universality, but also to improve quality And the equity of access to health services. Thus, ensuring that all citizens, regardless of their location or economic condition, receive the same level of care.
Along with this, many argue that the Colombian system has greater integration between the different levels of care (primary, secondary and tertiary) and health care and social services. It is believed that this would offer better coordination between hospitals, clinics and other health services. Consequently, patients would also be served more efficiently.
Do you think it's over? What nothing! Among the demands, there is also the consensus that the policies of transparency and responsibility they must be made stricter, in a way that intimidates corruption. In this regard, it would also help to simplify administrative processes, to reduce red tape.
Last but not least, Colombians agree that technology should be used more. Examples include telemedicine and the use of more robust information systems, as well as a greater incentive for innovation as a whole.
The discussion is still ongoing, so what would be your suggestion to them?
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