The Senate of the Republic received the presentation report for First debate of the bill 410 of 2025 Senate, accumulated with projects 312 and 135 of 2024 of the Chamber, which proposes an integral transformation of the health system in Colombia.
(See: Fiscal endorsement of health reform raises more public spending and less resources).
The document, based on September 22, arises as an alternative presentation in front of the original government initiative that was raised by Senator Norma Hurtado and seeks Respond to the problems of financial sustainability, access and labor precariousness faced by the sector.
The exposure of reasons indicates that “Colombia offers a remarkable example of rapid progress towards universal health coverage that deserves greater international recognition,” but warns that definance, access barriers and service quality demand background measures. The presentation collects the conclusions of technical tables with patients, governance, audits and human talent, as well as a tax debate with the Ministry of Finance.
One of the main axes is the creation of a social and community assurance model, which replaces traditional financial intermediation and guarantees effective access to services and medications. The articles establishes that the system must “Ensure that the entire population has equitable, timely and efficient access to health services and the medicines contemplated in the health benefits plan, regardless of their condition or personal characteristics”
(See: Fomag expands its pharmaceutical network with more than 1,100 dispensing points).
In addition, the project raises a National Health Council with a binding basis, to guarantee patients, scientific societies, guilds and territorial entities. During the discussions, experts warned that “A advice that only recommends lacks real power”, So SE proposed to strengthen their competences and provide it with decision -making functions. It also emphasized the strengthening of local health secretariats and the articulation of integrated service networks.
The guild warned that the Ministry of Health prepares a readjustment proposal, without consultation with the system actors.
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The presentation prioritizes primary health care (APS) as a gateway to the system. Primary Care Centers (CAPS) They would coordinate the provision of services and the reference to other levels of complexity. Scientific associations indicated the need to expand the training and use of family doctors and basic teams in remote areas, with differentiated incentives to guarantee effective coverage.
Resource management constitutes one of the most sensitive points. The administrator of health system resources (ADRES) would assume direct management of payments and audit. However, several sectors expressed repairs to the concentration of functions. At the governance table it was warned that “ADRES concentrates functions that must be controlled with each other, such as payment, management of expense and audit”, What could generate political interference and affect efficiency.
(See: Euthanasias continue to increase in Colombia: a procedure is performed every 25 hours).
To guarantee transparency, andThe project creates a unified interoperable public system in health (spuisis), which will allow the traceability of resources, concurrent audits and citizen access in real time. In the audit table, representatives of control entities stated that “the entity that manages or pays the resources should not be a judge and part”, so it was recommended to strengthen the independence of external audits and ensure impartial control mechanisms.
Human talent in health was another of the axes addressed. In the public hearing held in May, it was documented that more than 70% of the staff is linked under orders for the provision of services, with delays in payments of up to 180 days. According to the conclusions, Labor precarization is a structural problem inherited from Law 100 of 1993.
The senator said that the project proposes the progressive formalization of the staff, prioritizing the base, and estimated that “The complete formalization of human talent in health would require approximately $ 9 additional billion”
The passive-active relationship was 164% in 2025, reflecting technical insolvency of the system.
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The articulate contemplates the creation of a special labor regime for the health sector, with gradual implementation. In addition, it provides that Adres can directly pay the payroll, as happened during the pandemic. Union organizations argued that “ending outsourcing is an urgent urgency” and They demanded minimum salary scales per profession. The audience also showed that the sector is highly feminized, with 80% of women, forcing a differential approach to regulation.
(See: Government extends, for the second time, intervention to Famisanar: How long will the measure last?).
The fiscal component was approached in an unpublished debate in the Seventh Commission, which was attended by the Minister of Finance, Germán Ávila. The official recalled that the system went from covering 29% of the population in 1995 to 99% in 2025, with 51.9 million affiliates, but insisted that sustainability requires structural adjustments. He said, “Colombia requires a structural change in the health model that guarantees access to the fundamental right to health in a sustainable way”
Tensions between centralization and territorial autonomy were also evident. Representatives of Health Secretariats warned about the loss of local competences and the saturation of responsibilities with centralized resources. At the same time, from The government defended the need to strengthen state rectory to avoid fragmentation and dispersion of responsibilities.
Despite the dissent, the presentation identified consensus at five points: the need to reform institutional architecture, strengthen primary care, give real power to the National Health Council, dignify human talent and establish interoperable information systems. The report concludes that “a successful implementation requires a medium -term horizon with periodic evaluations.”
The legislative process of the project has faced eight extensions until September 2025, which reflects the technical and political complexity of the debate. The seventh commission of the Senate stressed that conscretation spaces with patients, user defenders, territorial entities, unions and academics were guaranteed to enrich the presentation.
(See: Possible liquidation of the new EPS would be a ‘smoke curtain’).
The articulate seeks to respond to what several intervenings described as a “humanitarian emergency” in the provision of services, marked by interruptions in the delivery of medicines, delays in allocation of specialized appointments and closures of institutions. The speakers pointed out that the proposal is a flexible base that must be adjusted with evidence and dialogue, in order to guarantee that the reforms effectively respond to the needs of Colombians.
Diana K. Rodríguez T.
Portfolio journalist
