A new technical report on health system performance shows growing pressures for access, opportunity and sustainability. Así Vamos en Salud’s Access and Opportunity Bulletin No. 6 shows continued fluctuations in membership, an increase in citizen complaints, setbacks in installed capacity and an increase in deductibles that are approaching the limit set by the World Health Organization (WHO).
The document, supported by official sources with historical traceability, uncovers trends affecting the availability of essential services, particularly in remote areas, and identifies requirements for national authorities, local authorities and insurers.
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The bulletin analyzes insurance indicators, the number of care services, the availability of hospital beds, the behavior of petitions, complaints and claims (Pqrs), guardianships for health services and expenses. According to the report, “effective access and options to health care are a fundamental basis for ensuring the right to health under conditions of equity and quality.”
In addition, this will be made more concrete Annual monitoring of Sispro data is necessary due to the six to nine month delays in consolidating the Individual Records of Provision of Health Services (RIPS) cube.which limits real-time analysis.
Although membership in the universal social security health system reached 99.6% in 2022, the document states that this recovery is not sustainable. By 2025, the national average coverage will be 98.6%, with a continuing downward trend.
The report highlights that the growth of the subsidized system compared to the contributory system reflects pressure on work formality and insurance sustainability. Así Vamos en Salud points out that “belonging is the starting point for the realization of the right to health and that its decline affects the justice of the system.”
Likewise, the analysis links these behaviors to significant territorial differences that affect actual access and the guarantee of justice.
The volume of services provided continues to increase. The system records:
- Since 2015, 10 million more people have received outpatient treatment.
- 63% increase in emergencies.
- 126% growth in hospitalizations.
However, this increase comes as the user experience deteriorates. Between June and August 2025, Pqrs grew by 36.4%; and if this trend continues, the year would end with more than 2 million complaints, the highest recorded in the historical monitoring of the indicator.
The bulletin also highlights that intervened EPS recorded the most significant increases. Nueva EPS, Sanitas and Famisanar concentrate the largest absolute number of complaints relative to the size of their subsidiaries. July saw a critical peak in this group of companies.
The behavior of guardians corresponds to this trend: They could reach 318,000 cases in December, an increase of 54% compared to 2019.
The analysis shows declines in critical areas for women and newborns. Compared to the previous period, the following is noted:
- 97 fewer beds in labor, delivery and recovery services.
- Progressive reduction in neonatal intensive care units.
- Total lack of a neonatal intensive care unit in Amazonas, Chocó, Guainía, Guaviare, Vaupés and Vichada.
Additionally, the bulletin points out that infrastructure is concentrated in major cities, deepening the divide between rural areas. In this point he points out that installed capacity is a pillar of strategic planning and its uneven distribution has implications for the response to unexpected events.
Only in the area of mental health is there a slight increase in beds, in line with the current challenges in this area.
Out-of-pocket expenses are analyzed as an indicator of financial security. The Ombudsman’s Office quoted figures from the National Administrative Department of Statistics (Danish): reports an increase from 15.8% in 2019 to 17.2% in 2024, an indicator close to the 20% threshold indicated by the WHO as the limit to be taken into account “catastrophic expenses“.
Several departments already exceed this level, including Tolima (35.68%), Guaviare (35.6%), Arauca (35.12%) and Putumayo (26.69%). The document notes that this behavior highlights economic barriers to entry that force users to cover increasing costs from their own resources.
In the words of Así Vamos en Salud: “The increase in deductibles reduces the financial protection of the system and has the greatest impact on the most vulnerable populations.“The Bulletin concludes that ensuring genuine access requires strengthening administrative management, improving installed capacity in critical areas, providing financial protection to users and ensuring timely information for decision-making.
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