Closing the Gap Between Formal and Material Health Care Coverage in Colombia

This paper explores Colombia’s road toward universal health care coverage. Using a policy-based approach, we show how, in Colombia, the legal expansion of health coverage is not sufficient and requires the development of appropriate and effective institutions. We distinguish betweenformalandmaterial...

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Bibliographic Details
Published in:Health and human rights 2016-12, Vol.18 (2), p.49-65
Main Authors: LAMPREA, EVERALDO, GARCÍA, JOHNATTAN
Format: Article
Language:English
Subjects:
Bioethics
Colombia
Delivery of Health Care - economics
Delivery of Health Care - legislation & jurisprudence
Delivery of Health Care - organization & administration
Government reform
Health care access
Health Care Reform
Health insurance
Health Services Accessibility
Healthcare Disparities
Human Rights
Humans
Insurance coverage
Insurance regulation
Insurance, Health - statistics & numerical data
Litigation
Population growth
Public Health
Right to health
Social insurance
SPECIAL SECTION ON UNIVERSAL HEALTH COVERAGE AND HUMAN RIGHTS
Universal Coverage
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Summary:This paper explores Colombia’s road toward universal health care coverage. Using a policy-based approach, we show how, in Colombia, the legal expansion of health coverage is not sufficient and requires the development of appropriate and effective institutions. We distinguish betweenformalandmaterialhealth coverage in order to underscore that, despite the rapid legal expansion of health care coverage, a considerable number of Colombians—especially those living in poor regions of the country—still lack material access to health care services. As a result of this gap between formal and material coverage, an individual living in a rich region has a much better chance of accessing basic health care than an inhabitant of a poor region. This gap between formal and material health coverage has also resulted in hundreds of thousands of citizens filing lawsuits—tutelas—demanding access to medications and treatments that are covered by the health system, but that health insurance companies—also known as EPS— refuse to provide. We explore why part of the population that is formally insured is still unable to gain material access to health care and has to litigate in order to access mandatory health services. We conclude by discussing the current policy efforts to reform the health sector in order to achieve material, universal health care coverage.
ISSN:1079-0969
2150-4113