Presentation (CTI)

OBJECTIVES: To evaluate the structure and sustainability of health system financing in Colombia, identifying challenges related to funding sources, fiscal balance, and resource allocation. The study analyzes how the current model—based on payroll contributions, taxation, and transfers from the General System of Participations (SGP)—can be strengthened to ensure long-term coverage and service quality.
METHODS: A policy and financial analysis was conducted using data from national health accounts (2018-2023), public budgets, and actuarial projections. Quantitative modeling included trends in per capita spending, vertical equity across regions, and contribution-effort ratios. In addition, 12 key informant interviews were performed with policymakers and finance officers from EPS, territorial entities, and the Ministry of Health to explore perspectives on fiscal sustainability and fund redistribution.
RESULTS: The study identified structural weaknesses in the revenue mix: the contributory regime covers only 45% of the population, while the subsidized regime relies heavily on volatile tax transfers. In rural and low-income regions, per capita funding gaps exceeded COP $400,000 compared to urban centers. Discrepancies in capitation payments (UPC) and delays in financial flows created service fragmentation and inefficiencies. Proposed solutions include: diversifying funding through earmarked health taxes, reforming intergovernmental transfers to enhance equity, and improving budget execution at the local level.
CONCLUSIONS: Sustainable financing is fundamental to achieving universal health coverage in Colombia. Strengthening the fiscal base, ensuring timely and equitable allocation of resources, and improving transparency in fund management are critical. A rebalanced financing strategy—combining efficiency with solidarity—can protect the health system from shocks, reduce regional inequities, and support long-term service quality and innovation.