Colombian President Gustavo Petro on Feb. 13 offered a set of controversial social and financial reforms to Congress targeted on the well being care sector. The federal government mentioned the adjustments would shield employees’ rights, enhance major care, increase entry to therapy, elevate well being care employees’ salaries and tackle corruption by eliminating personal sector administration of funds. On Feb. 14, hundreds took to the streets in help of the reforms, whereas the subsequent day, opposition-led demonstrators protested in opposition to them. What’s the present state of Colombia’s well being care system, and what particular reforms would do most to enhance it? How would the proposed well being care reforms tackle the problems the Petro administration outlined, and why are they controversial?
Anwar Rodríguez Chehade, deputy director of ANIF-Centro de Estudios Económicos: “The present Colombian well being system might be the largest achievement in social fairness over the past 30 years. Earlier than its creation in 1993, well being protection reached lower than 25 % of the inhabitants. Furthermore, simply 4 % of the inhabitants with decrease earnings was insured. As well as, assets had been inadequate and badly managed; an excellent a part of the cash was misplaced in corruption. Public hospitals, for instance, weren’t in a position to totally perform 12 months spherical. Earlier than, well being was a privilege for folks with sufficient cash to pay for it, whereas it was delivered virtually out of pity to essentially the most weak ones. Immediately, the present insurance coverage system has practically common protection (99 %), above regional pairs like Chile (93.4 %), Mexico (88.3 %) and Costa Rica (91.6 %), and it gives monetary safety in opposition to illness for all households. Originally of the Nineties, a Colombian needed to pay out 50 % of the full value of their well being bills out of pocket, whereas these days it’s merely 14.9 %, one of many lowest out-of-pocket figures, not solely in contrast with different international locations in Latin America but additionally with these within the OECD. Lastly, by way of high quality, greater than 80 % of Colombians consider the system nearly as good or excellent, and most significantly, there isn’t a distinction of the satisfaction ranges controlling for earnings. On this context, it’s worrisome—to say the least—that the backdrop of the well being care reform proposed by Petro’s administration will take us 30 years into the previous. We must be previous ideology and look ahead to fixing precise issues in our well being system, resembling having higher outcomes on therapy of communicable and noncommunicable ailments, offering care and entry in rural and distant areas and offering higher situations for well being employees. The federal government’s proposals should not new, and most of them have already confirmed to be improper up to now. Why would they work now?”
Maria Velez de Berliner, chief technique officer at RTG-Crimson Crew Group Inc.: “Colombia’s well being care system is neither honest, equitable nor accessible to each Colombian. However it’s neither damaged nor in want of being trashed. The proposed well being care regulation, now earlier than Congress, goals to destroy what works, albeit with flaws that want correction. The brand new regulation guarantees enhancements and expansions it can not ship as a consequence of an absence of funds and its cumbersome group during which communities, mayors and governors would resolve who receives care and of what kind, all decided by so-called group wants and requirements. No marvel even the president of the Senate, Roy Barreras, is in opposition to the proposed well being care norms and rules. Given widespread political, social, monetary and cultural opposition to the brand new regulation, it’s unlikely that Congress will approve it. Nevertheless, the door to well being reform is open. By means of it should cross 4 crucial reforms and expansions to the present system: 1.) Convey well being care to unserved, or poorly served, rural areas. 2.) Convey the 5 Entidades Promotoras de Salud (EPSs), now in default, underneath one umbrella EPS financed by the federal government however managed by a profitable EPS resembling Suramericana. 3.) Finance preventive reasonably than healing drugs. 4.) Don’t return to the outdated social safety system, which become a monetary and medical catastrophe for lack of well timed medical consideration, lengthy ready traces, poorly paid or outright incompetent workers and large, public waste.”
Javier Guzman, director of worldwide well being coverage and senior fellow on the Middle for International Improvement: “In 1993, Colombia launched into a serious well being sector reform, introducing necessary common social medical health insurance. Since then, the nation has made exceptional progress towards common well being protection, monetary threat safety and entry, no matter potential to pay. Protection elevated from 23.5 % of the inhabitants in 1993 to 99 % in 2022, out-of-pocket expenditures fell from 52 % in 1993 to round 15 % in 2019 and all residents inside the system are entitled to an equal basket of providers. In 2016, an impartial OECD evaluate acknowledged that ‘Colombia affords a exceptional instance of fast progress towards common well being protection that deserves to be higher identified internationally.’ Regardless of these spectacular achievements, the Colombian well being system faces vital challenges—monetary sustainability, regional and urban-rural inequities and an imbalance between major and specialised care. Insurers, that are principally personal, usually don’t handle medical and monetary threat appropriately, and poor employment contracts, inefficient cost programs and an absence of infrastructures in some areas hamper high quality of care, particularly on the major care stage. The Petro reform makes an attempt to resolve these issues by transferring to a quasi-Nationwide Well being System targeted on prevention and first care. Central and subnational governments, reasonably than insurers, could be chargeable for buying and offering well being care, well being care employees would have a particular work routine and the general public well being infrastructure could be strengthened. The reform is controversial as a result of it breaks from the system the nation has constructed over 30 years and a few have mentioned that the federal government is throwing the infant out with the bathwater. It could be higher to strengthen the regulation of insurers, present incentives to reward prevention and high quality of care and think about an alternate mannequin to distant and disperse areas.”
Carolina Batista, head of International Well being Affairs at Baraka Impression Finance and incoming member of the Motion Well being 2030 Board: “Regardless of the Colombian well being system’s achievements in latest many years towards common medical health insurance protection, vital challenges persist. The nation’s well being system has lengthy been acknowledged as fragmented, with restricted investments in major well being care and suboptimal infrastructure. The system strains to deal with the growing wants of Colombia’s getting old inhabitants, a steep rise in continual, noncommunicable ailments, persistence of infectious ailments linked to poor sanitation and insufficient distribution of the well being work power to cope with the urgent wants of Indigenous and different weak teams. With this in thoughts, there’s a want to rework well being care within the nation. This could require elevated public well being spending, major care strengthening, scaling up early screening and detection to shift focus from healing to preventive approaches and enhancing funding allocation to deal with challenges such because the rising demand for long-term care and implementation of well being know-how. An acceptable mixture of know-how adoption and innovation is important to develop new care fashions. The reform that President Petro has proposed goals to strengthen preventive care, assure the traceability of economic assets and enhance human expertise. There’s help for these goals, however important challenges are anticipated regarding its implementation. There are questions on the way it will successfully enhance entry to and high quality of well being providers, the way it will efficiently allow and scale digital transformation and its potential affect on the complicated logistics and provide chain of pharmaceutical merchandise, particularly in hard-to-reach areas. General, regardless of settlement on the necessity for reform, consultants say it shouldn’t be carried out with out an in-depth evaluation of present challenges, counting on numerous sectors, each private and non-private, with outlined milestones and transparency, and ideally with social participation from weak and underrepresented teams to make sure co-ownership and relevance.”
Alessandra Durstine, CEO and founding father of Catalyst Consulting Group LLC: “A populist dedication to serving the poor is taken into account a slam dunk in Latin America, however Colombia’s well being state of affairs is extra complicated as evidenced by widespread however opposing protests over President Petro’s proposed healthcare reforms. Final month, many Colombians celebrated Petro’s well being reform, which incorporates initiatives like well being employee coaching, community-based service supply and an emphasis on prevention—all of which can enhance major take care of marginalized communities. However, as Colombia’s inhabitants ages, its well being burden is shifting away from the infectious ailments that major care addresses and towards extra complicated and costly remedies for noncommunicable ailments (NCDs). The drastic shift to a public mannequin targeted on major care doesn’t mirror the present or future well being wants of a lot of the nation. Critically, the reform proposes to cast off the general public/personal mannequin of well being protection that has been the cornerstone of Colombia’s well being system for 30 years. Those that have been accessing care within the public/personal mannequin are deeply involved as a result of they worry that its full eradication will result in extreme gaps in service supply and protection, notably therapy for NCDs. So, similar to these in help of the reforms, in addition they took to the streets. Colombia is a rustic at an epidemiological crossroads. It suffers from the double burden of illness—infectious and noncommunicable. Petro’s plan is perceived to be overly targeted on major well being care, and by ending Colombia’s personal/public mannequin, many fear that the brand new well being care system wouldn’t be as much as the daunting job of assembly the well being challenges that Colombians face each at present and tomorrow.”
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