OECD: Colombia’s Health Care Is Universal In Coverage, But Serious Accessibility, Parity & Efficacy Challenges Remain

According to an OECD report, Colombia has significantly improved its health system over the past 20 years, leading to a rise in life expectancy and a fall in infant mortality. Infant mortality has fallen from 40 deaths per 1 000 live births in 1970 to 12.8 and life expectancy at birth reached 75.2 years in 2013. To maintain its ambition of universal, high-quality health care, Colombia should now focus on improving efficiency and strengthening financial sustainability, says the paper.

The OECD Review of Health Systems: Colombia says that almost every Colombian now has access to health care, with coverage nearly quadrupling from 23.5% of the population in 1993 to 96.6% in 2014. Health insurance coverage increased most rapidly among the poorest 20% of the population (from 4% in 1993 to 89%) and in rural areas (from 6.6% in 1993 to 92.6%).

All Colombians have access to a basic level health care services and have good financial protection from excessive health care spending if they get sick. Out-of-pocket expenditure paid by patients is only 14% of total health spending. This is one of the lowest proportions in Latin America and is lower than the OECD average of 19%. Unmet health care needs and waiting times for medical appointments have been significantly reduced.

On the ground however, Colombians without advanced coverage in their multi-tier health care system face long waits for treatment and medicine. Colombia has a system called EPS (Entidades Promotores de Salud – Health Promotion Entities), which provide the standard level of care that most employers must provide. There also is the POS (Plan Obligatorio de Salud – Obligatory Health Plan), which is the basic level of care all Colombians have access to. Private prepaid medicine and medical insurance are also available, which are similar to the US HMO/PPO/Indemnity plans. The prepaid and insurance plans provide the most advanced and convenient levels of care, with private hospitals and doctors that rival the rest of the developed world.

Those relying on basic EPS or EPS – Colombia’s system for the poor and indigent, face rationing, and may only receive subsidized prescriptions or care from the most basic, sometimes substandard facilities. The quasi-public health care providers often face financial difficulties, adding to the woes of those at the bottom of the resources ladder. Health care also varies greatly depending upon area. Predictably, wealthier areas have greater access to advanced care than poorer areas.

“Despite important achievements in recent years, the Colombian health sector still faces important challenges,” said OECD Secretary-General Angel Gurría. “The focus now needs to be on improving quality, efficiency and sustainability.”

Health insurers in Colombia have not yet developed into effective and efficient purchasers of health care services, according to the report. Payments to doctors, clinics and hospitals should increasingly reward health care quality and good outcomes, rather than volumes of health service provided, says OECD. The report recommends that Colombia work towards developing a stronger performance and accountability management for health insurers. More demanding performance management is equally needed for clinics, hospitals and other health care providers.

A more extensive set of health care quality standards and guidelines for primary care services should be developed. Also, a specialist training curriculum focused on preventing and managing chronic disease should be created for general practitioners.

Steps should also be taken to ensure that health system information is used as effectively as possible. The development of a more sophisticated information system will help Colombia extend its participation in international benchmarking efforts, such as the OECD’s Health Care Quality Indicators. This will be an important step for continuous improvement in health system quality and efficiency.