The current landscape of the healthcare sector in Colombia reflects a complex situation in which multiple factors converge, threatening not only the economic stability of the system but also that of all the stakeholders involved. This scenario compromises the coverage of essential services for users, as well as the full and timely fulfillment of the obligations derived from the provision of such services, thereby implying serious business risks for the private entities that participate in this sectoral dynamic. It has therefore become necessary to adopt legal measures that safeguard their interests.
- Difficulties in Financing the System
Since the enactment of Law 100 of 1993, one of the most critical aspects of the General System of Social Security in Health (SGSSS) has been its financing and sustainability. According to Article 156 of this law, “For each affiliated person and beneficiary, the Health Promoting Entity (EPS) shall receive a Capitation Payment Unit (UPC)…”, a value disbursed, as the case may be, by the Ministry of Health and the Administrator of the Resources of the General System of Social Security in Health (ADRES).
However, the operational reality of the system has revealed serious difficulties in calculating and paying the UPC, which has been subject to multiple criticisms by both internal and external actors of the system. Its update is based on general indicators that fail to adequately reflect the true costs of the sector, in addition to administrative auditing procedures that often delay the transfer of these funds.
This situation has, in many cases, generated the patrimonial insufficiency of the EPS to meet the financial requirements for authorization and to pay for the medical services provided by IPS (Healthcare Provider Institutions). This in turn creates a chain reaction affecting suppliers and healthcare personnel, who do not receive timely payment for their services. Ultimately, this has significantly impacted the quality, timeliness, and coverage of services provided to users.
Under this concerning scenario, no effective measures have yet emerged to counteract the crisis, pushing EPS toward forced liquidation or, alternatively, intervention by the National Health Superintendence. At the same time, extensive legal actions have been promoted, increasingly threatening the financial stability of the entities obliged to pay. Their resources are frequently affected by seizures, foreclosures, and withholdings that severely compromise their operations.
Likewise, payment delays limit the capacity of IPS to meet payroll and service expenses, while also preventing investment in technology, infrastructure, and training—critical aspects for maintaining care quality. Suppliers, on their part, face constant uncertainty due to the lack of necessary funds to cover operational costs, thereby increasing the risks of insolvency and loss of competitiveness in an increasingly demanding market.
- Constitutional Court’s Pronouncement on the Calculation and Adjustment of the UPC
This issue has not gone unnoticed by the highest judicial bodies, particularly the Constitutional Court. In its landmark ruling T-760 of 2008, the Court established certain parameters to ensure the proper financing of the Health Benefits Plan (PBS). It emphasized the need to review the UPC calculation process, ordering the incorporation of specific sector variables that more accurately reflect real costs.
In this context, the Court ordered the Ministry of Health and Social Protection (MSPS) to adopt a calculation methodology that includes not only the CPI and the minimum wage but also epidemiological profiles, associated risks, technological and operational costs of healthcare, loss ratios, inflation, specific allocations and inclusions, as well as the accumulated lag in the UPC value.
Nevertheless, the Special Chamber for Monitoring Compliance with Ruling T-760 of 2008 recently issued Order 007 of 2025, declaring “general non-compliance with regard to the sufficiency of the UPC in both regimes” and the “insufficiency of the 2024 UPC.” The Court noted serious deficiencies in the quality and validation of the information reported by EPS, as well as the reliance on inaccurate data provided by the Ministry of Health and Social Protection, increasing the margin of error and the lack of transparency in the process.
Thus, the Court reproached the use of historical data that does not reflect the current actual needs of the population, which negatively impacts the capacity to finance services included in the PBS.
Finally, the Constitutional Court ordered the MSPS to form a working group with the participation of key entities such as the Ministry of Finance, ADRES, EPS, IPS, the National Health Superintendence, and representatives from academia and patient organizations. The group must review UPC sufficiency, addressing issues such as the lag in the premium since 2021, the increase in loss ratios, and the need to adjust the calculation methodology with new variables and risk adjusters.
The scenario described undoubtedly represents one of the greatest challenges for the healthcare sector in 2025. Without a prompt and effective solution, it will lead to significant business risks. In this context, specialized legal advice becomes indispensable to protect the patrimonial interests of stakeholders in this sector. Such advice should enable the creation and implementation of corporate strategies and judicial defense mechanisms that minimize the negative consequences inherent to the current system model.
Based on this premise, in a sector where regulatory and economic uncertainty is constant, having allies who understand the complexity of the system and can offer effective legal solutions through preventive and strategic litigation approaches is essential.
