Health Care in Colombia

By RetirePedia's Roving Reporter Jim Veinot

Health care in Colombia is vastly improved, since Bill 100, enacted in 1993, compared to what was available to the public before that.

Accolades have been heaped upon the country for these improvements and in many ways the health care program in Colombia is very progressive.

However, like most things, the devil is in the details.

Fundación Santa Fe de Bogotá is one of the hospitals in Colombia that are accredited by the Joint Commission International.Fundación Santa Fe de Bogotá - One of the Internationally Accredited Hospitals in Colombia [Image source: eluniversal.com.co]

Although it’s tempting to enter the worldwide debate on Universal Healthcare we’re going to limit ourselves to only a few comments.

If you come from Canada, the UK, or an EU member country like Germany, you’re used to presenting your government Health ID card and being treated. In other countries, you present your insurance card for the same outcome. End of story, without complication. One tier, one card, one system.

However, in Colombia, there are choices to be made.

  • What level of insurance do you have? 
  • Is it valid for private health care in Colombia as well as public health care? 
  • Does your residency status affect your choices?
  • How about your age; what’s available to you if you’re a retiree over 60?

Those are the details I mentioned earlier.

Health Care in Colombia: Local Insurance Coverage

Local insurance coverage falls into three categories in Colombia; based not only on what is covered but who pays for it. The three categories are SISBEN, EPS and MP. A new version is a combo and we’ll talk about that as well.

SISBEN

SISBEN is a free, government subsidized insurance for very poor Colombians. It is awarded based on the result of a means test, and generally applies to Colombians with an income below (currently) $175 USD/mo.

This insurance provides health care in public facilities and has been a boon to much of the population. In spite of long waits and basic coverage, it is miles ahead of where the country was 20 years ago.

This is reflected in life expectancy (average now 72.5 yrs) and infant mortality rates. (Average below 14.5 per 1000 live births. This was previously over 82/1000.)

Entidades Promotoras de Salud (Entities for the Promotion of Health)

EPS (Entidades Promotoras de Salud) or Entities for the Promotion of Health is the next level and this is available to all Colombians and to anyone with a visa, including foreign retirees. These are insurers, qualified by the government, who have their own schedule of chosen practitioners and list of covered health care. 

Choosing an EPS is obligatory for Colombians not covered by SISBEN and will cost them up to 12.5% of their Colombian income. Employees pay 11%, the government pays 11.5%, and full payment is made by the self employed.

This coverage is available to retirees, as they have a visa. They will not have Colombian income, so the rate is based on three times the minimum wage in Colombia, currently about $700 USD. At 11% this would give rise to a monthly premium of about $77 USD.

There is generally a small co-pay with this insurance, and careful examination of the policy is required to determine what is covered and not covered. Some cover dental cleanings, others glasses for example.

You can only see a specialist when referred by a general practitioner. It’s important to ensure the company you choose has a contract with a GP in your neighborhood so you won’t be going across town to visit the doctor.

Medicina Prepagada (Prepaid Medical)

MP or Medicina Prepagada (Prepaid Medical) is the next level of insurance and covers everything in the EPS program, as well as above and beyond.

While there is legislation which ensures an expat retiree can be enrolled in the EPS program, there is no such legislation for the MP program. No Colombian company will enroll anybody over 60 years old in an MP policy. 

Some companies are ahead of the curve and now have a COMBO (my emphasis) or combination policy available to those over sixty years of age. You can then buy an EPS policy and an MP policy from the same insurer.

A company called Comfenalco, for example has offered what they call a Privileged Plan for $118.078 COP and a Superior Plan for $137.702 COP (2013). This is on top of the EPS plan fees.

Wherever you go in Colombia, carry your insurance papers with you. Often a calling card is a good idea if you need to check coverage at a location, because they won’t be letting you charge the call to them.

Otherwise you’ll pay for the service and then seek reimbursement from your carrier, so make sure that’s an option.

A visit to a General Practitioner runs about $35 and $80 to a specialist. These numbers change with the currency conversion rate, and are likely lower at the time of this writing (2016).

Health Care in Colombia: International Insurance Coverage

There are a host of international insurance companies more than happy to provide coverage, in Colombia or anywhere else you might be. Their adverts point to very extensive coverage, but they keep their rates close to the chest.

The rates are available if you request a quote, which is probably a good idea. That way you have an individualized rate rather than the generalizations I have provided here!

One has to assume that, given the high level of quality of health care available in Colombia, together with the low cost of living, that the private rates would be quite affordable.

Medical Tourism and Hospitals

Because the rates are so reasonable, the doctors so well trained and the facilities and equipment so first rate, Colombia has become a medical tourist center of attraction.

Medical tourism has become a goal of the government and they are succeeding. Several facilities have become JCI (Joint Commission International) accredited and several more are in the midst of review.   

For example, Fundación Santa Fe de Bogotá, Fundación Cardiovascular de Colombia, and Fundación Cardioinfantil are the hospitals in Colombia that are accredited by the Joint Commission International.

The above are some of the best facilities in the country. Specialization includes heart surgery, joint replacement, dental and cosmetic work, eye surgery, fertility and weight loss.

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