Bogotá, Colombia – The financial crisis within Colombia’s healthcare system isn’t just a headline—it’s a harsh reality affecting millions. From patients waiting for care to hospitals struggling to keep the lights on, the situation has reached a tipping point. But what’s causing this, and more importantly, how can it be fixed? According to experts, it’s not just about plugging holes but rethinking the entire approach to funding and managing healthcare.
Let’s break down the situation and the urgent solutions being proposed to save Colombia’s healthcare system.
A Perfect Storm of Financial Strain
If you’ve ever wondered how a country’s health system could run into such serious trouble, Colombia’s current situation provides a stark example. Several factors have come together to create a perfect storm: hospitals (IPS) are owed massive sums, health insurance providers (EPS) say the payments they receive—known as Unidad de Pago por Capitación (UPC)—are not enough, and pharmaceutical managers are refusing to supply medication without payment.
The heart of the issue? The system is grappling with a 9.5 trillion pesos shortfall projected for 2024, which adds to an already enormous debt of 23.4 trillion pesos. That’s 1.5% of the country’s GDP—a staggering figure. What makes this more alarming is that it’s not just a sudden crisis; this deficit has been building up for years, exacerbated by the pandemic and an aging population that demands more complex, expensive care.
For patients, this means delays, lack of treatments, and uncertainty. For the healthcare system itself, it’s about survival.
The Debate: Is the Funding Really Insufficient?
The government insists it’s doing enough. This year, the UPC was increased by 12.01%, which is higher than the country’s inflation rate of 9.73%. On paper, that sounds like progress. But dig deeper, and you’ll see why that’s not enough. For one, a significant portion of the budget is already earmarked for new initiatives, like home-based health services introduced by President Gustavo Petro. This means that of the roughly 1.5 million pesos allocated per person per year, less is available to cover old debts or rising healthcare costs.
So where’s the gap? According to Acemi, a group representing the EPS, for every 100 pesos they receive, they’re spending 102. They argue that healthcare demands are simply outpacing what the government is willing (or able) to pay for. Combine that with newer, more expensive technologies and treatments, and you have a recipe for financial disaster.
The Experts Speak: Solutions that Could Save the System
Now that we’ve outlined the problem, let’s focus on solutions. In a letter sent to the government in August 2023, signed by 31 former ministers, 8 ex-directors of planning agencies, and 60 health experts, a clear call was made: urgent action is needed. They requested an immediate transfer of 2.5 trillion pesos to help close the funding gap for 2024. But is that enough?
Augusto Galán, former health minister and current director of “Así vamos en salud,” suggests that the government must first acknowledge the problem. “We can’t fix a crisis we refuse to admit,” he states. His proposal? 5 trillion pesos to close the immediate gap—half to cover UPC shortfalls and the other half to fund “maximum budgets” (money reserved for high-cost treatments and medications).
His view aligns with Diana Cárdenas, former director of Adres, the agency that oversees healthcare payments. She points out that solving this crisis is not just about throwing money at it. The government must reassess the real costs, accept which debts are realistic to pay this year, and set a clear plan to pay the rest over time.
Where Will the Money Come From?
It’s a fair question: where do you find billions when public coffers are already strained? Here’s where some creative thinking comes into play. José Manuel Restrepo, a former finance minister, proposes a solution similar to the Ley de Punto Final—a law that allowed public debt to be used to cover healthcare liabilities. It’s not a perfect fix, but it would provide immediate relief.
Another idea floated by Luis Jorge Hernández from the University of Los Andes is to reconsider the scope of the basic healthcare plan itself. Right now, Colombia’s plan covers a lot, but as technology and medical care advance, those costs rise. According to Hernández, the system needs a reality check: “We may have to impose restrictions on the most expensive biomedical technologies and medications. It’s a tough conversation, but we need to prioritize what the system can actually afford.”
He also suggests increasing taxes on products that harm public health—think sugary drinks and cigarettes—to raise more revenue for healthcare. This is already being done in other countries and could provide much-needed funds.
Patients Are the Ones Paying the Price
At the end of the day, it’s not just about numbers—it’s about people. Jairo Núñez Méndez, a researcher at Fedesarrollo, puts it bluntly: “The ones suffering right now aren’t the EPS or the IPS—it’s the patients.” Especially those with chronic conditions, who rely on consistent care. With resources running thin, these are the people most at risk of being left behind in the crisis.
And this brings us to the crux of the issue. While there are many technical, financial, and policy hurdles to overcome, the ultimate goal is to ensure that no Colombian is denied access to healthcare. The system, flawed as it may be, exists for the people—and every delay in addressing the financial crisis directly impacts those most vulnerable.
Actionable Insights for 2024
- Immediate Funding Solutions: Experts suggest an urgent 5 trillion peso injection to cover this year’s deficits. Whether from redirected public funds or new taxes, swift action is required.
- Reevaluate the UPC: The current system isn’t keeping up with rising costs. A thorough recalculation based on real-world healthcare demands is necessary to close the gap.
- Reform the Basic Health Plan: To align services with what’s financially sustainable, Colombia may need to impose limits on expensive treatments and high-tech procedures.
- Explore New Revenue Streams: Targeting taxes on products that negatively impact health could be a win-win—both improving public health and generating additional funding.
- Keep Patients Front and Center: Above all, the reforms must ensure that patients do not suffer. Any solution that ignores their immediate needs will fail to address the human side of the crisis.
