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Colombian Health

Care System

December 2014

Mery C. Bolivar V.

Advisor of Ministry of Health and

Social Protection

Building systems for Universal Health Coverage: South-South Knowledge

Exchange with Korea

1. Health Reform in Colombia 2. Progress status of UHC: Access, outcomes and system structure 3. Level of ICT utilization in the healthcare sector 4. Issues/challenges

2

1. Country Information

• Population : 47.1 million • Woman: 51% • Urban population: 76% • GDP: USD$ 378.1 billion

(2013) • GDP per capita (PPP):

USD$7.826 (2013) • GDP in health: 6.8% (2013) • Real growth rate: 4,3% (2013) • Inflation: 1,9% (2013) • Unemployment: 8.4% (2013) • Gini: 0.539 (2012)

• Life expectancy: 79 (2012)

Country Information

Demographic Transition:

Aging Population

Source: DANE Colombian population of 2005-2012-2020, ( june 30 /2012)

Epidemiological Transition:

Changes in DALYs in 20 years

Source: http://vizhub.healthdata.org/irank/arrow.php

1. 1. Country Information

2. Progress status of UHC

3. Level of ICT utilization in the healthcare sector 4. Issues/challenges

6

2. Progress status of UHC: Access, outcomes and system structure

Fuente: Ministerio de Salud y MPS, las coberturas totales incluyen los regímenes exceptuados

6,3 mill.

18,9 mill.

4,6 mill.

23,2 mill.

23,5%

96,4%

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

80,0%

90,0%

100,0%

0

5

10

15

20

25

19

93

94

-95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

Contributivo (personas) Subsidiado (personas) Total* (% población)

Mile

s d

e p

ers

on

as

Colombia achieved Universal Health Coverage in January 2010

Health insurance

coverage rates

The increase in coverage solved the huge initial inequality. Not only

among income quintiles, but also between geographical areas.

Fuente: ECV, cálculos MPS

Affiliation by quintiles (income per capita for household) Affiliation according to geographical position

4,3%

87,9%

46,9%

92,5%

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

90,0

100,0

1993 1997 2003 2008 2010

Q1

Q2

Q3

Q4

Q5

23,7

88,7

31,1

88,8

6,6

88.,5

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

80,0%

90,0%

100,0%

1993 1997 2003 2008 2010

Nacional

Urbano

Rural

Health insurance

coverage rates

The boost in coverage has increased along with public access to the system. Measured by attendance to preventive consultations and lack of medical

assistance when required.

Fuente: ENDS y ECV, cálculos MPS

The preventive consult grew overall by 83% between 1997 and 2010. Mainly by the increase

of 109% in the poorest quintile of the population.

30,1

50,15

39

62,8

78,89

71,26

0

10

20

30

40

50

60

70

80

90

Q1 Q2 Q3 Q4 Q5 Total

1997

2005

2010

% p

obla

ción

The lack of assistance in case of illness, went from 19.2% in 1993 to 1.8% in 2010. In the poorest population, the decline was 33.2% at 1.3% in 2010.

33,2

7,3

19,2

1,3 1,4 1,8

0,0

5,0

10,0

15,0

20,0

25,0

30,0

35,0


1993

2003

2010

Health insurance

coverage rates

Out-of-pocket

expenditure

45,0

24,1

17,0 17,8 15,9 15,2 14,4

2,7

2,1

1,0 1,0 1,0 1,0 1,0

0,5

1,0

1,5

2,0

2,5

3,0

10

20

30

40

50

1994 1998 2005 2010 2011 2012 pr 2013 pr

% PIB %

Como porcentaje del gasto en salud

Como porcentaje del PIB

Source: MSPS. Dirección de Financiamiento Sectorial, Cuentas de Salud; DANE y DNP.

% OOP in total health expenditure

% OOP in GDP

One of the greatest achievements is the sustained reduction of

out of pocket expenditure

Additionally, results show an increase in the perception of quality

and opportunity of services

Fuente: ECV, cálculos MPS

* Para el año 2010 corresponde al acumulado del porcentaje de personas que respondieron buena y muy buena

Para los otros años es el porcentaje de personas que respondieron buena.

General consultation

Perception of users about service quality

76,6

78,5

84,3 84,6

70,0

72,0

74,0

76,0

78,0

80,0

82,0

84,0

86,0

88,0


2003

2008

2010*

2,93,6

6,2

7,2

10,9

6,4

3,12,75

4,09 3,9

5,8

3,8

0,0

2,0

4,0

6,0

8,0

10,0

12,0


2003

2010

Día

s d

e e

sp

era

Days it takes for the assignment of an appointment

General consultation

Achivements

Quality




12


Improve and maintain

health status

• Guarantee access to health services on health benefit packages (POS, ECAT, ATEP, NPPH, SOAT)

Provide finantial

protection

• Contributory Health Insurance (POS, SOAT, ATEP)

• Subsidize Health Insurance (POS)

• Public financed actions (NPPH, ECAT)

Achieve equity and

fairness

• Payroll taxes (contribution as a % of income)

• Solidarity fund (contributions+government budget+municipalities)

• Capitation independent from income

Colombian Health System Objectives

Objectives and

Strategies

General structure of

the health system

Congress

Ministry of Finance

CCTB

Ministry of Health and Social Protection

Ministry of Education

SOCIETY EQUALIZATION

FUND INSURERS

(SURROGATE)

PROVIDERS

INPUTS

HEALTH PROFESSIONALS

HEALTH SCHOOLS

1

2

3

8

4

5

6

7

1. Revenue Collection 5. Purchasing health professional 2. Pooling – Compensation 6. Prescription – Medical autonomy 3. Purchasing providers 7.Education 4. Resources 8. Provision of services (prioritized or non)

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Source: Cubillos adapted from Bolívar (2014)

Municipalities

Largely unregulated

Population

Providers Insurance

Companies

Payroll taxes rates, Subsidies,

Health benefit package

(POS)

Colombian State

Health care triangle

Healthcare delivery

Municipalities



Other sectors Social Determinants

Social and economical sectors

National plan of public health

Analysis of health situation

Health local plan

Colective action

Healthcare delivery

Municipalities Ministry of Health and

Social Protection


Insurers Primary provider

Complementary provider

Social Services

Quality standard

Risk manegment

Promotion and prevention



4. Issues/challenges

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3. Level of ICT utilization in the healthcare sector

ICT- SISPRO

Information system of health and social protection

(SISPRO)

Objetives

Information available, unified, opportune and

centered in the citizen by materializing the health

right, developing public politics and participating

of society

CIUDADANO

ICT - SISPRO

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• Incomes •Expenditures

•Risk factors •Health status •Utilization

• Insurer , beneficiaries •Focalization

•Resources •Plans and activities •Surveillance

RUAF, BDUA, PILA, ND,

SGD, SUPERVIVENCIA,

ESCOLARIDAD, PISIS

RIPS, ND, RLCPD,

PAI, SGD, PISIS,

RUAF-ND

Cuentas de salud,

Cuentas maestras,

Giro directo a IPS,

Saneamiento de

cartera, PILA, PISIS

SISMED, REPS,

SIHO, SGD, PISIS,

GEL

GEL, SGD

UGPP, RNEC, DIAN, MHCP, DNP, PAGADORES DE PENSION, DPS, CAC, MINEDUCACION, MINTRABAJO.

EPS, ET, DNP, CAC, ET, DANE, DPS

MHCP, ET, EPS, IPS, CONTRALORIA, PROCURADURIA, SNS

MINICT, CONTRALORIA, DNP, SECTOR

MINTIC, DAFP, SECTOR, DNP, ACR, UNIVERSIDADES

DATA- Public access

• Register

• Process

• Storage

• Recover

• Distribute

INFORMATION- Public access

Integration

Processing

SUPORT MAKING DECISION - Public access

• Operation

• Tactics

• Estrategies

• Regulation

• Monitoring

Data management Information

management Analysis and generation

of knowledge

ICT - SISPRO

COLLECTION INTEGRATION AND PROCESSING ARRANGEMENT

Enviroment

Resources People

Billing

Data management Information

management Analysis and generation

of knowledge

ICT - SISPRO

D

a

t

a

w

a

r

e

h

o

u

s

e

• User:

• Desing query

• Generate results

• Do his analysis

• Generante knowledge

Consult to demand

• User consult predefin report

• Report is avaliable by Internet

• Not is necessary account or password

Predefin reports

• Dinamic maps

• Indicators and variables

• Geographic ubication of event, providers and population

Geographic module

• Schedule vaccination

• Locate a vaccination point

• Healt indicators

• Autocare–cardiovascular risk

Mobile app

• Observatories

• M&S

• Registers

• Situational analysis

• Analitical model

Observatories and situational analysis

• Municipalities cards

• Chart of command in health by municpalities

• Maps of risk -ASIS

Caracterization of municipalities

ICT – SISPRO

Public access

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89 91

Gasto Per Cápita (Mujeres) Gasto Per Cápita (Hombres) UPC 86% F UPC 86% M

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 79 81 83 85 87 89 91

Gasto Per Cápita (Mujeres) Gasto Per Cápita (Hombres) UPC 86% F UPC 86% M

Risk adjustment capitated rate

ICT – SISPRO

Uses

1. 1. Country Information



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4. Issues/challenges

As we have already achieved UHC, we constantly ask ourselves what lays ahead:

1. Increased quality in service delivery

2. Breaching equity gaps 3. Enhanced governance, transparency and accountability However, we must be mindful of the need to preserve the financial sustainability of the health care system. Striking a fair balance between what we want to deliver and what we can afford is not an easy task!

Issues/challenges

1. Increased quality in service delivery

– To improve access to health services of adequate quality

– To address the increase of chronic non communicable diseases using a combined public health, health care and education strategies

– To systemically increase levels of perceived and objective quality in health care

– To sustain updated technological and pharmaceutical coverage within the financial and human constraints of the health system

2. Breaching equity gaps

– To use a rights-based approach to health care

– To prioritize vulnerable and marginalized groups

• Urban poor

• Rural communities

• Indigenous populations

• Sexual minorities

• Disabled patients

– To deliver services that are acceptable to cultural and religious minorities

– To create a sustained national multi stakeholder dialogue in health: building on the experience with SaluDerecho Initiative (World Bank)

– To leverage Open Government (Health) efforts

• Transparent decision making processes

• Systematic participation of citizens

• Accountable monitoring of policy implementation

• Transparency in hospital and delivery settings

– To enhance the effectiveness of our monitoring and control systems

3. Enhanced governance, transparency and

accountability

• On financial sustainability – To leverage additional sources of funding

– To increase efficiency of current funding

– To provide for reasonableness in the management of non covered health technologies

• Strengthening of ICT – E & m-health

– Integrate our systems so that we can follow an individual from its birth to its death (including each single clinical encounter)

– Systematization of claims and reviews processes

FINANCIAL SUSTAINABILITY AND ICT ARE IMPORTANT ENABLERS

THANK YOU

[email protected]

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