In recent months, a crisis in Colombia’s health system has been widely exposed to the public through numerous complaints from patients who have been denied access to medications and essential health services. This visibility is no coincidence: it is unfolding amid the debate over the health reform proposed by Gustavo Petro’s government. Those with stakes in health promoting companies (EAPB, commonly also referred to also as EPS), responsible for managing resources for healthcare, pharmaceutical multinationals, and parts of the political sector oppose the changes, as they stand to lose the exorbitant profits they currently reap.
Using their economic power and aggressive lobbying, these groups are manipulating public opinion and pressuring the National Congress to block any attempt at reform that threatens their interests, maintaining an unfair and exclusionary system that benefits only a minority at the expense of the health of the Colombian population.
Read more: Is health transformation possible in Colombia? Living sabroso, living healthy
During Petro’s administration, public denunciations have exposed the perverse maneuvers within the health system. The government has also intervened in several EPS, both contributory and subsidized, which claimed they were unable to continue operating. Shamelessly, these companies demanded that the government release “necessary” funds for their operations. Petro responded that “his government will not pay the debts accumulated by the EPS” and insisted that they fulfill their own financial obligations.
According to data presented to the Council of Ministers, the debts of the EPS amount to more than 15 billion pesos [approximately USD 3.5 million], while accounts payable for supplies and medicines owed to pharmaceutical companies are estimated at 1 billion pesos [about USD 237,000]. In response to this situation, Colombia’s Minister of Health, Guillermo Jaramillo, declared: “The government has increased the health budget; in the first year of this administration alone, there has been a 27.5% increase. The UPC has been raised like never before, always above inflation. We were accused of not increasing it, but previous governments were never held accountable when they raised it far below inflation.”
These are practices that undermine public health and the right to health and life, and below we lay out how the current system obstructs the implementation of the first compulsory license granted in the country.
The dolutegravir impasse
The first compulsory license for government use in Colombia was issued in 2023 for the drug dolutegravir, a crucial antiretroviral used in the treatment of HIV, recognized for its high efficacy. Its high price had posed a barrier to access, and the issuance of the compulsory license was the legal mechanism chosen to lower costs and expand availability.
According to the Colombian government, the estimated cost of dolutegravir treatment (commercially known as TIVICAY®) was approximately USD 1,235 per patient per year, based on prices recorded in the Medicines Price Information System (SISMED). By contrast, the cost of the same treatment purchased via the Pan American Health Organization (PAHO) was approximately USD 45 per patient per year.
However, the implementation of this legal measure has faced significant obstacles. On one hand, pharmaceutical companies have exerted pressure, falsely claiming that the compulsory license would discourage innovation. They have also labeled the measure illegitimate and illegal, fueling an intense debate within the country. The lack of clarity around regulations governing compulsory licenses has created uncertainty among healthcare providers and patients alike – resulting in limited access to the drug to this day.
Read more: Public Pharma vs. abusive prices: the case of the latest HIV-prevention drug
EPS have taken advantage of this gap to impose additional administrative barriers, which have further obstructed patients’ access to treatment. Although the Ministry of Health has promoted spaces for dialogue with healthcare providers, many have resisted implementing the necessary changes to facilitate treatment delivery. This situation only reinforces the lucrative and exclusionary nature of the health system, where health is treated as a business rather than a right.
The health reform proposed by President Petro seeks to achieve universal coverage and equity in access to health services, through strategies aimed at ensuring access via sustainable financing and the strengthening of the public system, with a strong focus on primary care.
However, the reform faces considerable hurdles, particularly due to the lack of political consensus regarding the elimination of financial intermediaries like the EPS – companies that are among the main beneficiaries of the current system and oppose the reform as it threatens their profits.
Colombia’s health system faces many challenges that require urgent action centered on equity and access to affordable treatment. The implementation of the compulsory license for dolutegravir is a crucial step toward ensuring access to essential antiretroviral medication, but it will require solid political will to overcome the entrenched obstacles. Guaranteeing the right to health for all Colombians must be the main goal of any public health strategy.
How Colombian healthcare works
The General Social Security Health System in Colombia, established under Law 100 of 1993, operates through a mixed vertical model that combines both public and private healthcare provision. Its financing is likewise mixed between the public and the private.
The system is primarily composed of three key actors:
- Health promoting companies (EPS, EAPB): these entities are responsible for managing the financial resources collected from public funds and workers’ contributions, and for ensuring access to medical services. They can operate in the contributory regime (for those who pay mandatory contributions) or in the subsidized regime (for people in vulnerable situations).
- Health service providers: known as health service provider institutions (IPSs), these include hospitals, clinics, and medical centers, which can be public or private. The health promoting companies contract these providers, along with companies responsible for distributing medicines, known as “logistics operators” or “pharmaceutical managers.”
- The Ministry of Health and Social Protection: this entity transfers funding through the Capitation Payment Unit (UPC) via the Administrator of the Healthcare Social Security Resources (ADRES). It also regulates and supervises the health system, establishes public health policies, and ensures compliance with regulations, as outlined in Law 100 of 1993.
This vertical structure, centered on financial intermediation, has created significant barriers to accessing healthcare services. Problems include the fragmentation of care, inequalities in access, poor service quality, particularly in rural areas, and corruption. The crisis deepened following the COVID-19 pandemic.
Read more: Colombia’s health system could finally see changes that put people over profit
It is fair to say that the Colombian healthcare system is openly profit-driven, and the realization of the right to health is not a priority. Trade barriers and prohibitive costs for many medications and treatments are clear indicators of an upside-down model. These high costs put the system’s sustainability at risk by increasing the burden on public finances, directly undermining the fulfillment of the Colombian population’s right to health.
Originally written by Juliana López Méndez (Fundación IFARMA) for the “Saúde não é mercadoria” column and published in Portuguese by Outra Saúde. Lightly edited for clarity and length.
People’s Health Dispatch is a fortnightly bulletin published by the People’s Health Movement and Peoples Dispatch. For more articles and to subscribe to People’s Health Dispatch, click here.
