Universal health care for Colombians 10 years after Law 100: challenges and opportunities

Colombia's 1991 Constitution reformed the country's public health care system. Per constitutional mandate: (subsequently developed by Law 60/1993 and Law 100/1993), (1) health is a right of all citizens, (2) the Social Security System must coordinate, provide and control an effective, universal and collective public health service, (3) health services management and delivery are decentralized to strengthen the role of departments and municipalities, (4) the private sector is incorporated within the insurance and health services delivery functions, and (5) basic health services are free and compulsory. After summarizing some of the most relevant Colombia's health system features, this article addresses four central aspects of the country's health care reform, namely: (1) the Unit of Payment by Capitation (UPC) as a provider payment mechanism, (2) asymmetries of information among the different agents of the General System of Social Security in Health (SGSSS), (3) the delegation by the Fund of Solidarity and Assurance (FOSyGA) of collection and control functions to Health Promotion Entities (EPS), and (4) the attempt to achieve universal health insurance as defined by Law 100. The article concludes with a description of various measures and political decisions necessary to ameliorate the financial crisis of the SGSSS and overcome difficulties in reform implementation.