OECD Reviews of Health Systems

English
ISSN: 
1990-1410 (online)
ISSN: 
1990-1429 (print)
http://dx.doi.org/10.1787/19901410
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These reviews examine the performance of health care systems in various countries, highlighting key challenges and opportunities for system strengthening based on international best practice. Each review provides targeted recommendations to improve health system accessibility, quality, efficiency and sustainability in the subject country.

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OECD Reviews of Health Systems: Colombia 2016

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English
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    http://oecd.metastore.ingenta.com/content/8115301e.pdf
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Author(s):
OECD
10 Dec 2015
Pages:
128
ISBN:
9789264248908 (PDF) ;9789264179042(print)
http://dx.doi.org/10.1787/9789264248908-en

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Colombia’s record in extending health insurance and health services to its population is impressive. In 1990, around 1 in 6 of the population had health insurance. Now, nearly 97% do, with greatest expansion occurring amongst poorer households. Likewise, in 1993 out-of-pocket spending made up 52% of total national expenditure on health. By 2006, this had fallen to less than 15%. Although Colombia has high rates of income inequality (with a Gini coefficient of 53.5 in 2012, compared to the OECD average of 32.2), access to health care services is much more equal. In urban populations, for example, 1.8% of children aged less than two years of age are recorded as having received no routine vaccinations, compared to 1.0% of rural children.  Colombia nevertheless faces important challenges to maintain and improve the performance of its health system. This report looks at Colombia’s health care system in detail and offers recommendations on what Colombia can do to ensure accessibility, quality, efficiency and sustainability.

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  • Foreword and acknowledgements

    Colombia’s record in extending health insurance and health services to its population is impressive. In 1990, around one in six of the population had health insurance. Now, nearly 97% do, with greatest expansion occurring amongst poorer households. Likewise, in 1993 out-of-pocket spending made up 52% of total national expenditure on health. By 2006, this had fallen to less than 15% (and remains low). Although Colombia has high rates of income inequality (with a Gini coefficient of 53.5 in 2012, compared to the OECD average of 32.2), access to health care services is much more equal. In urban populations, for example, 1.8% of children aged less than two years of age are recorded as having received no routine vaccinations, compared to 1.0% of rural children.

  • Acronyms and abbreviations
  • Executive summary

    Colombia offers a remarkable example of rapid progress toward universal health coverage that deserves to be better known internationally. It has achieved financial protection against excessive health care costs for almost all citizens, as well as an equal basket of services for those in and out of formal employment. Insurance coverage has risen rapidly from 23.5% of the population in 1993 to 96.6% in 2014. Affiliation increased most rapidly in the poorest quintiles (from 4.3% in 1993 to 89.3% in 2013) and in rural areas (from 6.6% in 1993 to 92.6% in 2013). Likewise, in 1993 out-of-pocket spending made up 52% of total national expenditure on health. By 2006, this had fallen to less than 15%, and remains one of the lowest figures in the region.

  • Assessment and recommendations

    Colombia has a well-designed health system, with broadly effective policies and institutions that other countries could learn from and that deserves to be better known internationally. Colombia has achieved financial protection against excessive health care costs for almost all citizens, as well as an equal basket of services for those in and out of formal employment. Insurance coverage has risen rapidly from 23.5% of the population in 1993 to 96.6% in 2014, with individual’s out-of-pocket spending on health care falling from 52% in 1993 to 14.4% of total national spend on health in 2013, one of the lowest figures in the region. Per capita allocation of funds for health care is equal for those in contributory and publicly-subsidised insurance schemes. Annual consumption of health care for those enrolled in contributory schemes, however, appears less equal at USD PPP 834 per year (2013), compared to USD PPP 449 for those enrolled in publicly-subsidised insurance (although the former figure includes transaction costs). Population health parameters are improving rapidly: life expectancy is now 72.1 years for men and 78.5 years for women (2013), around four years less than OECD averages, and infant mortality has fallen from 40 deaths per 1 000 live births (1970) to 12.8 in 2013 (OECD average 4.1).

  • Health and health care in Colombia

    This chapter presents the demographic and socio-economic context of the Colombian health care system and assesses the burden of disease that the system must address, including the legacy of the internal armed conflict. It describes the legal framework in which the health care sector operates, and how the system is financed. It also reports how Colombia is developing information systems to keep track of activities, costs and outcomes within the health care system.

  • Performance of the Colombian health system

    Over the last 20 years, Colombia has achieved remarkable improvements in access to health care services for disadvantaged populations, while reducing out-of-pocket payments as a source of health care financing, with likely positive implications for overall levels of financial protection. However, in spite of its recent achievements, the Colombian health sector faces important challenges to maintain and improve current performance levels.

  • Primary care in Colombia

    Colombia has a good base of policies, institutions, financial and informational frameworks in place to underpin delivery of effective primary care, including in rural and remote areas. The primary care sector is not as strong as it could be, however, and poorer health and access to health care persists in rural and remote areas. Several steps need to be taken if the ambition of having primary care front and centre of the health system, particularly to tackle chronic diseases, is to be realised.

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