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Viewing cable 08BOGOTA3352, COLOMBIA GAINING ON UNIVERSAL HEALTH CARE, BUT A

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Reference ID Created Released Classification Origin
08BOGOTA3352 2008-09-09 12:03 2011-08-25 00:00 UNCLASSIFIED//FOR OFFICIAL USE ONLY Embassy Bogota
VZCZCXYZ0000
RR RUEHWEB

DE RUEHBO #3352/01 2531203
ZNR UUUUU ZZH
R 091203Z SEP 08
FM AMEMBASSY BOGOTA
TO RUEHC/SECSTATE WASHDC 4573
INFO RUEHBR/AMEMBASSY BRASILIA 8365
RUEHCV/AMEMBASSY CARACAS 0984
RUEHLP/AMEMBASSY LA PAZ SEP LIMA 6541
RUEHZP/AMEMBASSY PANAMA 2288
RUEHQT/AMEMBASSY QUITO 7222
UNCLAS BOGOTA 003352 
 
SENSITIVE 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: ECON EFIN TBIO PGOV CO
SUBJECT: COLOMBIA GAINING ON UNIVERSAL HEALTH CARE, BUT A 
PRICE 
 
1. (SBU) SUMMARY: Since the 1993 implementation of national 
health care coverage in Colombia, the GOC has tripled the 
number of Colombians with access to public health services. 
However, the expansion has come with fiscal, legal, 
bureaucratic costs that are expected to rise further with the 
recent court-ordered increase in subsidized health services 
for Colombia's poorest.  Providers and independent observers 
agree that medical care in Colombia rates higher now than 
before universal care, but worry that legal challenges, high 
drug prices, and limited government resources could 
eventually hollow out the progress made.  END SUMMARY. 
 
More Coverage... 
---------------- 
 
2. (SBU) In 1992 less than 20 percent of Colombia's 
population had health insurance or financed access to health 
care services.  In 1993, the Colombian Congress passed Law 
100 which created a universal health care system with an 
employer-employee contributory plan and a subsidized plan for 
low-income and informal sector Colombian worker which 
received funds from the contributory plan and the GOC. 
Coverage has since increased to 74 percent of the population. 
 While still not universal, independent experts such as 
Amelia Fernandez, Dean of the Medical Faculty at Javeriana 
University, tell us that much of the population remaining 
outside the system consist of Colombia's 3 million-plus 
internally displaced persons, remote rural communities, and 
individuals who have not obtained sufficient personal 
identify documentation to register for the subsidized program. 
 
3.  (U) Of the nearly three-quarters of Colombia's population 
that participate in the national health care system, 45 
percent participate in the subsidized program covered by the 
30 percent of higher-income Colombians in the contributory 
system.  Under both plans, participants have access to a 
health maintenance organization-style list of service 
providers in their local community.   Under the contributory 
plan, Colombian workers contribute 12 percent of their salary 
to the program with employers covering one-third and the 
employees covering two-thirds.  One and half percent of the 
funds collected through the contributory plan, together with 
GOC fiscal resources, help fund the subsidized system which 
has until recently consisted of a more limited slate of 
services. 
 
But More Costs too 
------------------ 
 
4. (SBU) Critics point out that since implementation of the 
national plan 15 years ago, costs have grown steadily due to 
extensive bureaucracy, endless legal challenges over which 
services the plans cover, and rising costs of prescription 
medications.  Juan Carlos Fernandez, President of Famisanar, 
one of the licensed private health care companies contracted 
by the GOC to provide coverage under the national plan, told 
us that rising costs have squeezed his company's margins to 
around 2 percent.  He placed blame on GOC regulators for 
setting rate tables too low and creating expensive 
bureaucratic hurdles which lead to rampant patient legal 
claims.  Fernandez also said his company and many other 
service providers often find it impossible to receive 
reimbursement from the subsidized public health fund for 
services they provide to low-income Colombians and 
subsequently have to absorb the cost. 
 
5. (SBU) Following an August 2008 Colombian Supreme Court 
decision ordering an expansion of subsidized services under 
the national health care plan, experts expect the financial 
pressure on the system will grow even more.  Under the court 
order, the national plan will now have to provide the same 
set of services to subsidized plan members as contributory 
plan members receive.  Fernandez told us he expects the cost 
of the decision will run as high as USD 2 billion with the 
GOC having to cover the cost from fiscal resources rather 
than employee or employer contributions. 
 
Money Still To Be Made 
---------------------- 
 
6. (SBU) Despite the increasing costs born by the 20 contract 
service providers licensed under the national plan, many have 
prospered under the privatized system.  Today, companies such 
as Colsanitas, Colsubsidio, and Cafam, which started as 
employee savings funds, provide health networks to both 
 
contributory system participants and subsidized system 
participants and have branched out to lucrative value-added 
products.  In particular, many of the providers offer 
supplemental "pre-paid" service packages for middle and 
high-income workers to complement the health services covered 
by the national plan.  Other providers, such as Colmedica and 
SaludCoop, now own their own hospitals and clinics as well as 
non-health sector assets such as hotels and even a soccer 
team. 
 
Better than Before, but Room for Improvement 
-------------------------------------------- 
 
7. (SBU) Independent expert Amelia Fernandez described the 
system as philosophically sound but in need of improvements 
in implementation.  In particular, she said the GOC needs to 
strengthen management of the system by the Superintendency 
for Health in order to reduce the number legal complaints 
over service claims and clarify benefit packages before costs 
spiraled out of control.  Nevertheless, she echoed the 
assessment of Juan Carlos Fernandez and other service 
provider representatives that access to affordable medical 
services has dramatically improved in the last 15 years and 
that the national health care system, despite its ongoing 
challenges and uncertain financial future, remained a 
success. 
NICHOLS