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Colombia spent an estimated US$16.3bn on healthcare in 2009, equivalent to 7.1% of GDP. Real GDP growth is expected to rise from an estimated 0.2% in 2009 to 2.5% in 2010, before picking up gradually throughout the remainder of the forecast period. Healthcare spending as a share of GDP rose slightly from 7.1% in 2009 to 7.2% in 2010. This growth is much slower than during the boom years of 2004-07. The weaker growth and difficult fiscal situation in 2010 will limit the government's ability to expand coverage or deepen benefits, as well as the ability of consumers to pay out of pocket for healthcare services and medicines.
Health issues are likely to rise up the political agenda in 2010-12. Economic challenges will highlight the problem of inequality of access to healthcare, while the need for fiscal adjustment will draw attention to the failure of increases in total healthcare spending to produce proportionate improvements in terms of health outcomes. As a result, the government will come under pressure to increase total spending on healthcare, while ensuring tighter controls on the allocation of funds. Success will depend on tackling deep-seated difficulties in the management of the flow of resources within the system.
The growth of private insurance schemes is likely to be strong during the forecast period. A steady, although unspectacular, expansion of formal-sector employment will underpin solid growth, and an extra stimulus could come from the government’s efforts to increase compulsory healthcare contributions. However, the likely impact of the latter is uncertain, as the task of reducing the high levels of contribution evasion may continue to prove difficult.
The current healthcare system was initiated by a 1993 law that opened the way for a rapid expansion of private healthcare. The law established that employees and employers must contribute to health insurance schemes, with a separate, subsidised scheme for some of the unemployed and the very poor. The system has serious shortcomings, as around one-third of the population does not belong to either the general or subsidised insurance systems; and both systems, as well as many of the public-sector hospitals and clinics that provide the care, have experienced financial difficulties. Transparency International, a non-governmental organisation (NGO) that aims to highlight the problem of corruption, has found that there is a high risk of fraud in the Colombian system within both healthcare delivery bodies and the state-level agencies responsible for directing, co-ordinating and monitoring healthcare services. Of the total of around 1,000 healthcare institutions in operation, around two-thirds belong to the public sector.
Consolidation is taking place in the healthcare sector and will continue over the forecast period, with the smaller and less efficient Empresas Promotoras de Salud (EPSs, healthcare promotion enterprises responsible for contracting services with hospitals and clinics) being swallowed by stronger competitors. The difficulties for vulnerable EPSs have been compounded over the past few years by judicial rulings forcing them to provide full treatment and medicine for high-cost illnesses that were not originally included in healthcare plans. The stronger private-sector EPSs will grow not only by taking market share from the weaker ones, but also through government reforms, which have extended healthcare coverage to the whole population. They have also reduced the scope of the state system, therefore increasing the potential for private-sector participation.
Colombia is a high risk country for bacterial diarrhoea, hepatitis A, dengue fever, malaria, yellow fever and leptospirosis.
Average life expectancy at birth was an estimated 72.8 years in 2009. Infant mortality is high, at around 17 per 1,000 live births in 2007 (according to UNICEF), although it has declined in recent years and is down from 28 in 1990.
In 2007 there were around 170,000 people living with HIV/AIDS. This is down from 190,000 in 2003.
The findings of the Health of Nations Index are presented here, along with accompanying information and data on over 50 countries.
Start by scrolling around the map. Hovering over a country will reveal its index results. Click through to find the underlying data and other profile information. Use the tabbed filters above the map to browse by category filter.
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