BTN News: The Colombian government’s latest attempt to overhaul the national healthcare system has reignited fierce debate and concern among health experts, political leaders, and the general public. On Friday, September 13, 2024, the Ministry of Health, led by Minister Guillermo Alfonso Jaramillo, quietly submitted a new health reform proposal to Congress, maintaining core elements from a previous reform that was struck down last year. Critics, including 19 former health ministers, argue that this new proposal poses serious risks to the health of Colombians and fails to address the country’s mounting healthcare crisis. With significant changes to how healthcare is delivered and funded, the reform has sparked intense discussions about the future of Colombia’s health system.
Health Reform Submitted: A Quiet Move Creates a Stir
Without prior notice or fanfare, the Ministry of Health submitted a revised health reform bill to Colombia’s Congress. This action immediately provoked backlash from various sectors, including a group of 19 former health ministers. They argued that the proposed changes could undermine the healthcare system, stating in a public letter, “Many of the provisions in the new bill endanger the health of Colombians.”
Minister Guillermo Alfonso Jaramillo, in a subsequent statement, clarified that the newly presented bill is fundamentally the same as the one introduced by former Health Minister Carolina Corcho, which was rejected in the previous legislative session. “This is not a new bill,” Jaramillo declared, noting that while the number of articles has been reduced from 130 to 48, many of the previous bill’s measures could still be enacted via decree.
Key Concerns: What’s at Stake with the Reform?
Former officials, including well-known figures like Augusto Galán Sarmiento and Alejandro Gaviria, have raised concerns about the lack of substantial changes in the new bill. They worry that the proposed reform does not adequately address the underlying financial problems that have plagued Colombia’s healthcare system for years. These issues have resulted in significant service gaps, such as delays in medical appointments, inadequate delivery of medicines, and a rising number of complaints.
Denis Silva, representing “Pacientes Colombia,” warns that the reform could lead to a fragmented and inefficient healthcare model. “This could create a system where responsibilities are divided among too many players, leaving patients in a state of uncertainty,” Silva remarked.
Major Changes: New Structure, Same Problems?
The reform aims to dismantle the current Health Provider Entities (EPS) and replace them with “Health and Life Managers,” shifting their role from insurance providers to coordinators of healthcare services. Additionally, the reform emphasizes strengthening Primary Health Care (APS) through the establishment of Primary Care Centers (CAPS) and the deployment of territorial health teams in rural areas.
However, critics argue that the proposed changes may lead to further fragmentation. The new system would involve multiple entities, such as Health and Life Managers, Primary Care Centers, and local health departments, potentially complicating coordination and governance.
Financial Viability: Can Colombia Afford the Reform?
A major point of contention is the financial feasibility of the proposed reform. The National Association of Financial Institutions (Anif) has highlighted a staggering deficit in the health sector, totaling 9.7 billion pesos between 2021 and 2023. The proposed reform, which involves centralizing resources in a single public health fund, is estimated to cost 113 billion pesos over the next decade—equivalent to the cost of six major tax reforms.
Luis Jorge Hernández from the University of the Andes warns, “The reform is financially unsustainable. It would require an enormous influx of funds, potentially forcing cuts in other areas of the national budget.”
Experts Question Government’s Approach: “Lack of Clarity and Coordination”
Former Health Minister Alejandro Gaviria has criticized the government for its lack of transparency and consultation in drafting the new bill. “The supposed national agreement is a deception,” he stated on social media platform X (formerly Twitter). Gaviria argues that the reform, which he describes as almost identical to the previous version, lacks a clear strategy for managing the healthcare system’s current financial crisis.
Healthcare Providers Express Concerns: “Uncertainty and Fragmentation”
Healthcare providers and organizations such as Acemi, which represents the main EPS, have also expressed surprise and concern over the bill. “We have not been informed about the content of the reform being presented to Congress,” said Mario Fernando Cruz, Vice President of Acemi. He emphasized the need for a comprehensive agreement involving all stakeholders in the health system to ensure stability and continuity.
The Broader Impact: A Struggling Health System at Risk
The debate comes amidst a deepening crisis in Colombia’s health sector. The number of lawsuits for access to health services has increased by 42% in the first four months of 2024 compared to the same period in 2023. Experts like Augusto Galán Sarmiento point to delays in patient care and medication delivery as signs of a system under severe strain, exacerbated by ongoing financial challenges.
María Claudia Lacouture, President of the Colombo-American Chamber of Commerce, argues that before pursuing significant reforms, the government should prioritize addressing immediate financial gaps. “The priority must be stabilizing funding to ensure hospitals and clinics continue operating and lives are saved,” Lacouture stressed.
Fiscal Realities: A Reform in Need of Funds
The Ministry of Finance has acknowledged the fiscal challenges associated with the reform. A recent report projects that health system expenses will increase significantly in the coming years, rising from 99.6 billion pesos in 2025 to 148.6 billion pesos by 2034. Critics warn that the proposal lacks sufficient funding sources to cover these costs, risking a fiscal shortfall of 15.6 billion pesos by 2024.
Looking Forward: Uncertainty Ahead
As Colombia grapples with the biggest health system crisis in 30 years, many fear that the proposed reform could worsen the situation. Without a clear plan to address financial deficits or improve coordination among health providers, the future remains uncertain. Alejandro Gaviria succinctly summarized the concern: “This is a reform for the future when our health system doesn’t even have a present.”
Conclusion: Colombia at a Crossroads in Healthcare Reform
With the new reform bill now in Congress, Colombia faces a critical decision on the future of its healthcare system. While the government argues that the reform will create a more equitable and efficient system, critics remain deeply skeptical. The debate over the proposed changes is far from over, and the path forward will require balancing financial realities, stakeholder interests, and the urgent needs of the Colombian people.
