The debate on health reform returns to Congress with a new version of the bill that will be discussed in the Seventh Commission of the House of Representatives. After the file of the initial proposal in 2023, The Government insists on transforming the current insurance model, with the aim of broadly restructuring the General System of Social Security in Health.
According to an Anif analysis, the Ministry of Health explained that the structural problems of the system justify the initiative. According to the portfolio, “Although the current system managed to expand universal coverage of the right to health, this implied a progressive increase in government spending”
(Read: Fomag expands its pharmaceutical network with more than 1,100 dispensing points)
By 2024, 38.6% of the sources of the system came from the General Budget of the Nation (PGN)and official projections indicate that, with the reform, that percentage could reach 44% on average in the next decade.
Another of the government’s arguments is that the growth of assurance spending has not been reflected in an effective prevention of diseases. “The current model is oriented towards the attention of pathologies that could be prevented through early interventions”, Said the exhibition of reasons.
The portfolio also highlighted the financial unfeasibility of the Health Promoting Entities (EPS). Of the 157 historically authorized, 129 have been liquidated, and currently 52% of the affiliates are in EPS intervened. The fourth factor indicated is vertical integration, which allows EPS to provide services with their own clinics and hospitals, a practice that, according to the government, eliminates competition and has weakened public hospital institutions.
(See more: Possible liquidation of the new EPS would be a ‘smoke curtain’)
The nation’s contributions to the health system would reach $ 96.2 billion in 2036.
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However, in August 2025, the Ministry of Finance presented the fiscal endorsement that supports the viability of the reform and details the route of expenses and sources of financing. In terms of uses, The document states that direct expenses will concentrate 96% of the system budget in 2026 and will remain at similar levels during the next decade.
Primary care will be the fundamental pillar of the new model and will absorb the greatest proportion of resources. According to the ministry, The spending path will go from representing 5.9% of GDP in 2026 to 7.6% in 2036with the pressure concentrated in primary care and medium and high complexity services.
As for the sources of financing, the nation’s contributions will be the most weight. In 2024, these resources were $ 38.9 billion (constants of 2025) and, according to the guarantee, will reach $ 44 billion in 2026 Already $ 96.2 billion in 2036. The contributory regime quotes are maintained as the second most important source, with a projection of $ 37.5 billion in 2026 and $ 49.7 billion in 2036, growth that starts from the assumption of a sustained increase in formal employment.
(See also: Supersalud orders new EPS to legalize payments with providers)
52% of health affiliates are in intervened EPS.
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The guarantee also incorporates other sources such as 100% of the collection of taxes on ultraprocessed foods and sugary drinks, The levies to alcoholic beverages, the social VAT equivalent to 0.5% of the total collection of VAT and resources of the General Participation System (SGP).
Despite the structuring presented, the document recognizes risks in sustainability. In the case of medium and high complexity care, the preventive approach could generate greater costs than those projected, because massive screening and early detection of diseases would increase the demand for specialized procedures.
Another identified risk is the institutional strengthening of the administrator of the resources of the Health System (ADRES), which must centralize the flow of resources and process millions of invoices daily. According to the report, “Technological costs, human resource and infrastructure necessary for this institutional transformation could significantly exceed current estimates”
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The joint assets of the EPS was from -$ 12.4 billion to July 2025.
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In the income front, projections on contributions depend on the growth of formal employment, which is uncertain in a labor market with more than half of workers in informality.
The document warns that “The increase in contributions to the rate of economy growth seems optimistic”. Risks are also identified with healthy taxes, whose nature seeks to discourage the consumption of ultraprocess products and sugary drinks, so their collection tends to decrease in the medium term.
The guarantee does not contemplate the effects of the Law of Competencies derived from the reform to the SGP approved in 2024, which introduces uncertainties on the projected resources. The redistribution of competencies towards territorial entities could reduce the fiscal capacity of the central government and limit its margin to finance the system.
(See: New EPS statutory reform opens the way to financial risk and in care network)
The new EPS recorded a negative heritage of -$ 6.2 billion and liabilities of $ 21.4 billion as of March 2025.
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EPS pressure
Another pressure front is at the financial closure of EPS. The transition to a model of managers contemplates resources to cover liabilities and clean up public entities such as the new EPS, but the sufficiency of the funds is debatible.
The document recognizes that “Although the aforementioned measures could temporarily relieve the financial obligations of the sector, they could involve fiscal costs in case such guarantees or compensation are not subject to the expense ceiling of the health sector”
The financial situation of the EPS accentuates these doubts. The Colombian Association of Company Companies (ACEMI) reported that the joint assets of these entities was $ 12.4 billion to July 2025, not counting the new EPS. The Comptroller revealed that the negative heritage of the latter reached -$ 6.2 billion in March 2025, product of liabilities for $ 21.4 billion, well above the $ 6.7 billion estimated in the endorsement.
(See more: Controversy between promotion grows and thus we go in health by report on special regime)
Diana K. Rodríguez T.
Portfolio journalist
