The presidential elections on Sunday June 19 in Colombia open several debates, including the health model. In a country with extensive health coverage, but where the majority of providers are private companies, the presidential candidates focus on how to make health more accessible, but also more efficient.
Two years of pandemic have left a sore health system in Colombia. Both health workers and users have noticed it: in 2020, more than 800,000 complaints were filed about health care, 13% more than in 2019. In addition, like all countries, Colombia is in mourning for the almost 140,000 deaths since the start of the Covid-19 pandemic, a crisis that has been avoided with a relatively rapid vaccination campaign that has immunized 70% of the population.
And it is that the Colombian health system is not weak: it covers 95% of its inhabitants, one of the highest rates on the continent. However, this figure hides strong territorial inequalities, such as the almost 100% coverage in Bogotá, the capital, or the incomplete 70% of regions such as Guainía, according to figures from the Ministry of Health.
In addition, it faces other challenges, such as the lack of professionals in this field. Colombia has 1.2 doctors for every 1,000 inhabitants, a figure well below the OECD average of 3.4, a figure that reveals the precariousness of the profession in the country and also the workload faced by workers, something that led several health unions to join the 2021 National Strike protests, the largest seen on Colombian streets in decades.
In fact, one of the reasons for the protests of the National Strike was, neither more nor less, a health reform endorsed by the conservative government of Iván Duque, which encountered strong opposition for not solving the structural problems of the system and for taking steps towards a model that unbalanced the balance towards private management, which currently already has a great weight through the so-called EPS, health companies that are the main ones in charge of providing health services to Colombians by the Government.
Currently, all those who have a job contribute directly to health services by paying 12.5% per month of their salary, while those who cannot afford it or who earn less than a minimum wage, are in a subsidized regime, where the The State is responsible for subsidizing access to the health circuit. Currently, approximately 23 million Colombians access health in this way.
This is the country that the leftist Gustavo Petro or the conservative populist Rodolfo Hernández will receive after the presidential elections that face them on June 19.
The proposals of Rodolfo Hernández
The axis Hernandez’s program, not only in health matters, revolves around efficiency and the fight against corruption within Colombian institutions. That is why one of its main proposals is to streamline State payments to EPSs to prevent the debts of individual persons from impeding the operation of these companies.
On the other hand, Hernández has insisted on a “family” model of medicine, where the user also has “responsibility” for his own care and assures that he will seek to improve the working conditions of health personnel.
Another of his ideas is to give a basic income to the elderly, a proposal that could help improve access to health for this segment of the population, especially vulnerable and dependent on health care.
On the other hand, one of the proposals that made headlines for “giving away free drugs” consists of taking a census of people addicted to psychoactive substances and providing them with these substances as a measure to fight drug trafficking and to try to approach this problem from a public health perspective.
However, some organizations such as Échele Cabeza, which works on responsible drug use, spoke out to remind that these types of measures are only used for people with addiction who have not been successful with any other treatment and to emphasize that it would be ineffective against drug trafficking, since Colombia only consumes 2% of the cocaine it produces, for example.
Beyond his program, Rodolfo Hernández has spoken out on abortion to say that he will respect the decision of the Supreme Court, which recently legalized the voluntary interruption of pregnancy until the 24th week. However, there is distrust of feminist organizations around this issue and others that deal with women’s rights due to various outbursts of a macho tone by the candidate.
Regarding other recent health debates in Colombia, such as euthanasia, Hernández does not make anything explicit in his program, but states that he is in favor of this measure according to “the severity of the applicant’s illness”.
Gustavo Petro’s proposals
The leftist program It has a clear objective: to move from the current public-private model to a public one that does not depend on Colombians’ ability to pay, but instead achieves universal basic coverage through taxes.
Some of his programmatic points coincide with those of Rodolfo Hernández, such as improving the working conditions of health workers and strengthening the local pharmaceutical industry.
Among other proposals, Petro speaks of having “intercultural” health systems where the ancestral knowledge of native peoples, Afro-descendants and Raizales, among others, also have a space in health coverage.
In addition, he plans to implement a system that he already launched during his mayoralty in Bogotá called “doctors at home”, but this time to reach all of Colombia and thus reinforce the preventive perspective of health and improve access and coverage in the regions. where it is still needed.
On the other hand, Petro is a defender of free, safe and free abortion and has also stated that he will support and implement the Court’s judicial decision in this regard. In addition, he has also spoken out in favor of euthanasia.
Among other health proposals, it proposes medical and psychosocial support for gender transition for trans people.
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