Interview: Alejandro Gaviria

What measures is the government taking to build a sustainable and equitable health system?

ALEJANDRO GAVIRIA: To build a sustainable health system, it is first necessary to identify the major sources of income and expenditure. New technologies, an ageing population and higher social demands are some of the major destinations of health care expenditure in the country. It is worth mentioning that out-of-pocket health costs in Colombia are among the lowest in the region, accounting for only 14% of overall health care costs, compared to an average of 35% in Latin America. In this regard, Colombia’s per capita health care expenditure is around $600 per year, while in the US it is $8000. Colombia has to increase its health expenditure by incorporating new technology, raising salaries in the health sector, improving the pricing structure and formalising nearly 200,000 employees. If we take these variables into account, health expenditure is expected to increase by 1% of GDP in the next five or six years. We have implemented policies to overcome the financial problems – stemming mainly from technological pressure – that are hindering the development of the health system. We have also introduced international standards in relation to pricing medicines and for authorising bio-similar medicines to enter the local market. These challenges have the potential to stimulate competition between pharmaceutical companies in the country and to eliminate barriers to access. In the medium term, and in light of the Mandatory Health Plan (Plan Obligatorio de Salud, POS) that was regulated under the statutory law, one priority will be to find new sources of financing to build this sustainable health system.

What kind of impact will the Ley Estatutaria, or statutory health law, have on the sector?

GAVIRIA: The provision of health care is a universal right in Colombia, clearly defined and regulated in the country’s legal framework. In this regard, the Ley Estatutaria is the first of its kind worldwide, based on a fundamental social right. Some provisions of the law are set to be implemented immediately, including the obligation to provide emergency services, general rules about autonomy and medical self-regulation. The next steps will follow over the coming two years, during which we will have to define the rules that will govern the new POS. We will also have to establish the mechanisms to manage the exclusions from the plan and to determine the services and technologies that will be included as general benefits. In this way, the entire Colombian population will have access to all levels of health services.

How can access to health care be improved?

GAVIRIA: With the implementation of a new initiative called zonas dispersas, or scattered areas, we have made great progress in providing health care to remote regions that are difficult to reach, such as Guainía. This model can guarantee medical services in the country’s most remote areas, which is done by creating innovative solutions to overcome limitations on access and improve the quality of medical care in villages that are separated from major urban centres. By making advancements in this direction, we are on the right path to enhance the quality of care – and by extension the living standards – of our population. This is the reason why the National Development Plan (Plan Nacional de Desarrollo, PND), recently approved by Congress, includes a policy for medical care. The PND has in particular emphasised a strategy that is focused on the provision of preventative care, as well as on defining methods to provide medical care as efficiently as possible according to the type of population and the level of risk involved. Another area we are emphasising is a healthy environment where people can live, work or study, while also strengthening the primary health care providers such as medical posts, medical centres and low-complexity hospitals.