In the middle of this year’s closing, in which the government publishes the main economic indicators, a key information for the quality of life of Colombians was missing: the Capitation Payment Unit (UPC), which is the amount that the government transfers to intermediary companies that manage health, called Health Promotion Entities (EPS), for each affiliated citizen. The Ministry of Health announced on Tuesday that this value would increase by 9.03% for the contributory scheme – for which the majority of Colombian workers and employers contribute – and by 16.49% for the subsidized scheme – under which the most vulnerable populations are covered. In total, the budget will increase from 89.8 billion in 2025 to 101.3 billion in 2026, which represents an increase of 11.6 billion pesos.
This is a significant figure, but for the health sector it is an insufficient increase, especially when compared to the historic 23% minimum wage increase announced the day before by President Gustavo Petro. Juan Carlos Giraldo Valencia, doctor and director of the Colombian Association of Hospitals and Clinics, expressed his concern in a video statement on Tuesday because “there is a significant gap between the increase in the minimum wage and the adjustment approved for the UPC, which endangers the sustainability of the health service delivery sector.”
According to Giraldo, this measure breaks the balance that keeps the system on its feet, since a difference is generated between the obligatory expenses of the system – for example, in salaries – and the income that can be obtained through the UPC. According to experts, the health system operates on the basis of the minimum wage. “We ask the national government to reconsider in particular the figure of the contributory system and to maintain a certain degree of balance between these variables,” he added.
The health union argued within government that if the UPC figure was not significantly increased, the health system would remain stuck in a financial crisis from which it would be very difficult to recover. The same Constitutional Court had ordered at the beginning of this year that the Government revise the UPC that it had established for 2024 and 2025, by 5.3%, because the court considered that it was insufficient for the EPS to cover all their costs; The delays, he explained, could be detected from 2021.
Ana María Vesga, president of Acemi, the association of contributory EPS, affirms that the government’s increase for the subsidized regime, of 16.5%, is in accordance with “the order of the Constitutional Court to equalize the regimes and will surely be a relief for more than half of the population of this regime”. But in the case of the contributory system, the 9% increase “is very far from what we might expect”, especially when we aspire to that of 17%.
This is a worrying announcement, adds Vesga, knowing that this second plan includes the largest amount of health spending. “The Ministry of Health does not recognize that there is a very significant actuarial delay in the system, which is manifested in the enormous debts that exist between insurers and providers, and in the whole crisis that has arisen for patients and for care in recent years,” says the director of the union.
Health sector experts have repeatedly questioned Petro’s position, which has kept the UPC lower than what the EPS requires. For them, it is a government strategy to finish breaking up the current health system, which the president has failed to reform through a bill. Health reform, which at the start of his term was presented as his signature proposal, was twice rejected in Congress, delaying further discussion throughout this year. The president, however, maintains his fight against the EPS, still active, which he denounces on several occasions for allegations of corruption or inefficiency in the management of public resources.
Given the serious financial problems, through the Superintendence of Health, the Petro Administration currently controls eight EPS with more than 23 million members. The largest is one of them, the Nouvel EPS, which provides care to 11 million people and which was the subject of government intervention in 2024. This has not contributed to improving the service, according to its members.
In recent days, the EPS has been in the news because the pharmacy Droguerías Colsubsidio announced that it would suspend the delivery of medicines to its members from January 1, a decision that it had been waiting for since November and which was motivated precisely by the entity’s late payments to the pharmacy. The announcement of the increase in UPC contributions, criticized by the union as not being sufficient to remedy the financial crises in the sector, only increases the economic tension which, for several years, has exerted pressure on a degraded health system.
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