“A process that must start with progress and be built with all stakeholders”

Since the year 2023, the new Colombian government proposes a reform aimed at modifying the following elements:

• Focus on primary care and the corresponding establishment of a network of healthcare centers, with a focus on preventive and predictive medicine.
• Availability of itinerant medical teams that visit families in the regions.
• Managing resources through a healthcare system resource administrator, responsible for payments to public, private, or mixed healthcare providers.
• Improving working conditions for healthcare personnel and ensuring continuous education.
• Transforming healthcare benefit plan administrators into service managers and removing the function of financial risk management.
  

The last significant change in our country's healthcare system dates back to 1993 when we transitioned from a healthcare system with direct state functions to a public insurance model provided by public and private entities. The financing for healthcare services is through contributions from those with purchasing power in the form of taxes or deductions, along with state subsidies for the poor or those unable to pay. The state exercises a regulatory, supervisory, and control role, with administrators responsible for healthcare and financial risks. Lastly, there is a network of public and private healthcare providers contracted by the administrators.

The payment base per system affiliate is defined by a per capita payment unit that covers an implicit service plan, including most technologies and services, except those defined in an explicit list of exclusions.

While there is high coverage in insurance, close to 100%, effective availability or access is not as high, leading to dissatisfaction among the population. This is compounded by issues with the flow of resources or payments between the system's stakeholders and a deficit in payments for some services that were not covered in the past.

There has been significant progress in the quality of healthcare services and interventions that have had an impact on the life expectancy of Colombians and health indicators, resulting in high rankings in international healthcare system evaluations. However, inequities persist in remote areas compared to urban centers due to the lack of availability and questions about the calculation of payment per patient, especially after the experience with COVID-19.

The reform proposed by the government is currently under legislative consideration, and it has faced opposition due to the way it is being processed, the lack of clarity regarding the change of agencies responsible for managing benefit plans, the fragmentation of the system's functions, financing guarantees for primary care components, and services currently covered by a per capita payment unit per patient, which is considered insufficient or lacking recent studies to assess its coverage of healthcare needs. Lastly, there are concerns about the functions and responsibilities the state should exercise in the healthcare system.

Prior to this reform proposal, concerns were focused on the efficiency of the system in generating patient-centered outcomes, evaluating technologies in terms of real benefits, prices based on value, coverage of technologies for rare or orphan diseases, and the nature of the relationship between administrators and risk-sharing providers that would promote trust and impact risk management. However, intense political debates have hindered progress on these issues.

ISPOR Colombia continues to create spaces for democratic, plural, comprehensive, and constructive discussions from academic and institutional perspectives. These discussions aim to provide an objective evaluation of the current state of the Colombian Healthcare System, highlighting its strengths, weaknesses, and opportunities, focusing on topics related to the core mission of our Scientific Society and those in which we are invited to participate. Furthermore, we have emphasized the importance of researching healthcare outcomes in other countries or contexts, recognizing their strengths, opportunities, and limitations, which must be critically assessed before formulating public policies for implementation. Our ultimate goal is to promote initiatives that maximize healthcare outcomes, benefiting the Colombian population, and enhancing the capabilities of different stakeholders in the healthcare system.

Submitted by Juan Guillermo Barrientos Gómez, ISPOR Colombia Chapter President