Colombia’s health system has moved from chronic strain to a full-blown crisis over the past four years, as a government push to eliminate the role of private insurers backfired, according to a detailed assessment by a leading Bogotá-based newspaper. The initial reform agenda—strengthening stewardship, primary care and service delivery—was distorted, producing results contrary to those intended and threatening to reverse health indicators. A lack of consensus, erratic management inside governing entities and permanent confrontation have left patients and their families bearing the heaviest cost.

The most consequential misstep, the analysis argues, was the obsession with dismantling the managed-competition model built around EPS (health-promoting entities). After three failed legislative attempts and several frustrated decree-based efforts, the government intervened directly in major insurers including Nueva EPS, Sanitas and Savia Salud. The state now controls insurers that together cover roughly half the national population. Far from bringing relief, these interventions worsened financial and access indicators and were marked by poor governance, reflected in a high turnover of official intervenors.

The financial picture is stark. The per-capita payment unit (UPC) remains a contested figure, but several estimates point to a shortfall of at least 10%, equivalent to a deficit of nearly COP 10 trillion. Meanwhile, the judiciary has repeatedly checked executive action. The Constitutional Court ordered the return of one EPS to its owners in 2025 after finding due process had been violated, and similar rulings in 2026 compelled the return of Savia Salud and Coosalud. The same court blocked an attempt to divert 5% of the UPC to finance basic health teams, ruling the measure unconstitutional.

Not all developments have been negative. The consolidation of ADRES as a single-payer fund with the capacity to make direct payments to providers and logistics operators, and the creation of an information system that brings traceability and transparency to spending, are cited as advances worth preserving. The push for primary care, including basic health teams, is also noted as a wager that needs review and strengthening. Yet the overall balance, the assessment concludes, is overwhelmingly in the red, with the system’s legitimacy eroded by early declarations that it was “one of the worst in the world”—a diagnosis that, lacking rigorous international comparison, undermined confidence without offering a constructive path forward.