| Resumen: |
This case study provides an overview of the contribution of Colombia s compulsory health insurance, particularly its Subsidized Regime (SR), to universal health care coverage in the country, and the current challenges the SR faces. The case study is based on discussions with stakeholders from academia and the public and private sectors. Key policy issues presented here were part of a policy dialogue conducted within the framework of the knowledge and convening services program of activities financed with resources from the World Bank s Nordic Trust Fund for Development and Human Rights.
In the early 1990s, Colombia launched a major health sector reform establishing a compulsory health insurance system with two main regimes: the Contributory Regime (CR) and the Subsidized Regime. The reform aimed at introducing a managed competition model where private health insurance was supposed to foster efficiency, quality, and cost containment. The CR was designed to cover all individuals in the formal sector and their dependents. Individuals without any health insurance coverage have access to ambulatory and inpatient services through the public hospital network managed by municipalities. Individuals eligible for CR and SR have health insurance coverage provided by health plans known as (Empresas Promotoras de Salud, (EPS). The EPSs organize the delivery of health services through a variety of arrangements that include contracting with individual public and private health care providers. |
