Intended for healthcare professionals


Colombia’s response to healthcare crisis

BMJ 2012; 344 doi: (Published 23 February 2012) Cite this as: BMJ 2012;344:e802

This article has a correction. Please see:

  1. Oscar Bernal, assistant professor1,
  2. Juan Camilo Forero, research assistant1,
  3. Ian Forde, research fellow2
  1. 1School of Government, Universidad de los Andes, Carrera 1 No 19-27, Bloque AU, Tercer Piso, Bogotá, Colombia
  2. 2Department of Epidemiology and Public Health, University College London, UK
  1. Correspondence to: O Bernal obernal{at}
  • Accepted 29 December 2011

In 2009 Colombia declared a state of emergency in its healthcare system. Oscar Bernal, Juan Camilo Forero, and Ian Forde describe the origins of the crisis and explore the extent to which the reforms that followed are likely secure better healthcare for the population

Colombia is struggling to provide an affordable and effective health system for its population. As in most of Latin America, its healthcare challenges include rising chronic diseases, persistent infectious diseases, and worsening inequity. More uniquely, around 3.4 million people are registered as internally displaced1 and, although declining, murder and intentional injury remain major problems. Almost half (45.5%) of Colombians live below the poverty line, and the country’s Gini coefficient, a measure of inequality, was 0.587 in 2009,2 the highest in Latin America.

Colombia currently ranks 87 out of 187 on the United Nation’s human development index with a per capita gross domestic product (GDP) of $9800.3 Around 5.8% of GDP is spent on healthcare, infant mortality is 15.5 deaths/1000 live births, and life expectancy at birth is 73.7 years.3 4 These statistics compare favourably with neighbouring countries, as the table shows. However, rising costs, waiting lists, and poor quality have left the system in disarray.

View this table:
Table 1

Health and development statistics for Colombia and neighbouring countries

Origins of health sector crisis

Before 1993, healthcare was provided through a single public insurer. Planning was highly centralised and poorly responsive to changing needs; furthermore, 30% of Colombians were uninsured, and out of pocket payments made up 53% of total healthcare spending.6 In 1993, Law 100 introduced private insurers under regulated competition. People in formal employment could opt to purchase health insurance through regular salary contributions, while those who were unemployed, informally employed, or very poor remained publicly subsidised.

The law specified a basic package of services to which members …

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