Colombia's Health System on the Brink
The EPS Crisis and a June 20 Deadline

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Colombia's health system is shaking, and the trouble has a name: the "EPS crisis." Of the bodies that run health insurance there — the EPS — 15 of the 28 are effectively going under, covering more than 30 million people, and a four-year-old reform bill expires on June 20. But the real point of the story is where the damage lands. When the "front door" to care jams, the first to be hurt are the people who need it without a break — those who depend on ongoing rehabilitation and assistive devices.

What an EPS actually is

EPS stands for Entidad Promotora de Salud. In Colombia's public health insurance, it's the body through which a citizen reaches care. The tricky part is that an EPS is not a hospital. The place where a doctor examines you or performs surgery — in Colombia, an IPS — is something separate. The EPS registers members, contracts with hospitals, pharmacies, and rehab centers, and coordinates so that the patient can actually reach the care they need.

In Japan, when you feel ill you take your insurance card and go to the hospital. In Colombia, an EPS sits squarely between the patient and the providers. Which hospital you can use, which pharmacy fills your prescription, which specialist you're referred to, where you do your rehab — much of that is arranged by the EPS. So when an EPS runs well, the patient reaches care through the system. To the patient, the EPS is the front door to health care.

That door is now jamming.

Public money flows in — so why does it jam?

The EPS is part of a public system. The state sets the framework and the funding, hands each EPS a fixed amount per member (the UPC), makes them compete, and lets citizens choose among them. With this 1993 design, Colombia pushed insurance coverage up to around 97%. The EPS model was not a failure from the start; at getting everyone into the system, it worked.

The problem is that the EPS role grew too large. Contracts with hospitals, the supply of medicines, referrals to specialists, the management of payments — the EPS holds all of it. So when an EPS falls into financial trouble or mismanagement, medicines don't arrive, specialist appointments can't be booked, tests are delayed, surgeries are postponed, rehab stops — all at once. In fact, 15 of the 28 are reported insolvent, and complaints over delayed medicines and appointments have hit records; the regulator, Supersalud, has ordered every EPS to strip out those barriers at once, according to local reporting. The very thing built to widen access has also become the bottleneck that blocks it.

So the EPS crisis isn't simply "an insurer is failing." It's that the system's front door to care has jammed, and people who hold the right on paper can't actually reach it.

What the government wants to change

The Petro government argues the EPS-centered system is itself the problem, and wants to shrink the EPS role and strengthen public management. Leaving the EPS to manage the money, it says, has left patients' rights underprotected.

The other side fears that weakening the EPS abruptly, or moving members to other EPS en masse, would throw the system into chaos. Indeed, Infobae reports that a decree to shift 6.6 million people to the largest EPS was suspended in May by the top administrative court — it could violate the right to choose your insurer, and dumping huge numbers onto a single struggling body would break the continuity of care.

That's the hard part. The current system has real problems. But break it suddenly and treatment may stop. In that tug-of-war, the four-year-old reform bill reaches its session deadline on June 20. Miss it and the bill dies automatically — back to the start.

It lands hardest on people with disabilities

What deserves special care in this crisis is the effect on people with disabilities. For them, health and welfare aren't a one-and-done. Rehab, medicines, specialist visits, orthoses and other devices, regular reassessment — these usually have to continue.

Even a single orthosis takes a long chain: the doctor's decision, a professional assessment, insurance approval, coordination with the supplier, the fitting, repairs, reassessment. An EPS sits somewhere in that chain. So if the EPS seizes up, an application stalls, a repair can't be done, rehab is cut off, a specialist can't be reached. What's frightening is a "temporary" disruption: even a few weeks or months of delay can take a real toll on someone's quality of life or physical function.

What this crisis is really asking

The EPS crisis looks complicated, but its core isn't. The EPS is the door through which people reach care, and when it tilts, the care recedes even though the right remains. The government is trying to reform it — but treatment could stop mid-reform.

The questions underneath are these: how do you protect the right to care inside the system; how do you divide public responsibility and private operation; how do you reconcile efficiency and fairness; and what do you do so that, in the middle of reform, patients aren't left behind.

Japan's own assistive-device benefit system puts the prefecture in the middle as the reviewing body. If the body in the middle stumbles, the benefit can stop with it. That fragility isn't Colombia's alone. That's why I'm watching June 20 from a distance.

When the body in the middle tilts, the first thing to break is the care of those who most need it to continue.

This article is the author’s commentary and opinion based on public information. Please confirm the latest details, figures, and procedures with governments and primary sources. Quotation is kept minimal and sources are cited.