Overview
The current General System of Social Security in Health (SGSSS) was consolidated by Law 100 in 1993. It seeks equal benefits between contributory and subsidised schemes. It is made up of the Ministry of Health and Social Protection, the Health Promotion Agencies (EPS) responsible for both membership and collection of contributions.
What happens if you need to see a doctor?
Employees or pensioners join contributory healthcare schemes, as do self-employed workers whose income is equal to or greater than a minimum wage. They can choose a public or private contribution, where they make a monthly contribution of 12.5% (8.5% by the employer and 4% by the employee). Contributors and beneficiaries make moderating fee payments when they visit the specialist, undergo laboratory examinations and/or receive medication. Beneficiaries make co-payments for hospitalizations, treatments or surgical procedures, according to the contributor’s Basic Contribution Income.
The subsidised scheme insures people without capacity to pay do not have to. People in level one do not pay for services or treatments. The scheme covers a Compulsory Health Plan across health care institutions and should guarantee referral to a specialist doctor once a diagnosis or medical reference is received.
Who decides what medicines a doctor can prescribe?
The prices of medicines and types of medicine that can be prescribed are regulated by the National Commission for Medicines and Medical Devices, which establishes a maximum selling or reference price in pharmacies.
Practically, what is it like to live with Type 1 in Colombia?
By law, for both contributory and subsidised persons, consultations with specialists (which the doctor considers appropriate) and inputs such as oral hypoglycemic agents, insulin, syringes, needles, glucagon, glucometer are covered (one is given annually to those who use insulin), Strips, lancets and strips to measure ketones in urine, according to what the specialist orders and justifies, may also be provided.
In order to do so, contributors must be aware of their contributions or of the payment of moderating contributions. Inputs can be delivered once a month or every 3 months. However, people on a subsidised basis generally face delays in the delivery of supplies.
If a person decides to purchase an insulin pump (without supplies) on their own, the price to pay is around 5,000 USD. People who choose to receive specialised care at a diabetes association or private practice can pay from 60,000 (17 USD) to 137,000 (38 USD) for approximately, per consultation.
Education in diabetes is provided to people who first start insulin treatment. Subsequent education is not covered by the EPS or the plan, but each laboratory or company (Sanofi, Lilly, Novo Nordisk, Abbott, Medtronic, etc.) has its diabetes educator who is in charge of training in various topics and management of technologies. The cost of the sessions are covered by each laboratory.
Although doctors know about the existence of diabetes educators, sometimes they do not refer their patients. Also, there are cases where some people with diabetes ask their doctor about the possibility of using the insulin pump and they are told that it does not work, preventing them from having access to such technology. The same has happened with the FreeStyle Libre continuous glucose monitoring sensor.
People’s ignorance of their rights impacts access to both care and to the supplies and technologies that by law must be provided, as long as it has medical justification.
What about getting admitted to hospital?
To get admitted to the hospital, you can arrive at any clinic or hospital with ER (emergency) services where a nurse or a doctor will evaluate the case by doing a triage. If the person is in a very high risk situation, they will be admitted immediately but if the risk is lower or if it’s a situation that doesn’t need immediate attention, they will be assigned to a wait list, a priority appointment or next day appointment. At the time of admission, certain identification and medical documents usually will be requested.
How does diabetes care vary throughout the country?
The regions of Bogotá, Antioquia and Valle del Cauca reported higher prevalence of type 1 diabetes.
Thank you to Natalia Hincaoie Vasquez and Angela Moreno Sosa who kindly contributed to providing this information.
Last updated 2022