Key points
- Colombia runs the Bismarck model: mandatory social health insurance through the General System of Social Security in Health (SGSSS), created by Law 100 of 1993, which made healthcare a legally enshrined right.
- Coverage is near-universal: 99% of the population is covered for a core set of services, up from 24% when Law 100 began, through a contributory regime for people in formal employment and a subsidised regime for people not in formal employment.
- Care is delivered by health service providers (IPS) — public and private — contracted by health insurers (EPS) that people choose; the insurers manage clinical and financial risk for their affiliated populations.
- Households paid 14.6% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database), one of the lowest shares in Latin America at the time of the OECD review.
- Life expectancy at birth was 77.5 years in 2024, and health spending was 8.1% of GDP in 2024 (OECD Health at a Glance 2025).
Direct answer: Colombia runs the Bismarck model: mandatory social health insurance through the General System of Social Security in Health (SGSSS), created by Law 100 of 1993, which made healthcare a legally enshrined right. Coverage is near-universal: 99% of the population is covered for a core set of services, up from 24% when Law 100 began, through a contributory regime for people in formal employment and a subsidised regime for people not in formal employment. Care is delivered by health service providers (IPS) — public and private — contracted by health insurers (EPS) that people choose. Households paid 14.6% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database). Life expectancy at birth was 77.5 years in 2024 — and healthy life expectancy 66.7 years — and health spending was 8.1% of GDP in 2024 (OECD Health at a Glance 2025; WHO Global Health Estimates, October 2026).
At a glance
| Item | Detail |
|---|---|
| Model | Bismarck — mandatory social health insurance (SGSSS) |
| Who pays | Compulsory contributions pooled nationally: in the contributory regime employees pay 4% of income and employers 8.5%, and the subsidised regime is funded by government and municipal revenues and cross-subsidy transfers; government and compulsory schemes accounted for 70% of health spending in 2023 |
| Who delivers | Health service providers (IPS), public and private, selectively contracted by the health insurers (EPS) people choose, in a managed-competition model with a purchaser–provider split |
| What is free at the point of use | Services in the Mandatory Health Plan (POS) for affiliated people; access is uneven, and people appeal to the Constitutional Court for treatments outside the guaranteed basket |
| Life expectancy at birth | 77.5 years (2024, OECD Health at a Glance 2025) |
| Health spending | 8.1% of GDP (2024, OECD Health at a Glance 2025) |
| Source for the model and coverage | OECD Reviews of Health Systems: Colombia 2016 |
Figures are a snapshot checked 7 November 2026, not a live feed. No country is ranked as best.
How the system works
In 1993, Law 100 brought about far-reaching reforms by creating the General System of Social Security in Health (SGSSS). The reform made health insurance mandatory for all those who could afford it, created a single national pool for insurance contributions, split the purchaser and provider functions, and encouraged competition by allowing individuals to choose their insurer and allowing insurers to selectively contract with providers. Crucially, under Law 100 healthcare became a legally enshrined right of citizens, rather than a service dependent on charitable supply. Before the reform, coverage extended to only 24% of the population and was highly unequal: 47% of the richest quintile had coverage, against 4.3% of the poorest.
Individuals become affiliated with the SGSSS through three regimes: the contributory regime for individuals in formal employment, the subsidised regime for individuals not in formal employment, which historically offered a less generous basket of services, and the much smaller Special Benefit Regime, which includes the armed forces, teachers and a state-owned petroleum company. Risk-equalisation and cross-subsidy exist both within and across the contributory and subsidised regimes. In the contributory regime, employees pay 4% of their income and the employer 8.5% to a fund called FOSYGA. Coverage reached 96% of the population at the time of the OECD review in 2015, and 99% are covered for a core set of services in the latest OECD figures. The gains came largely from new affiliations in the subsidised regime, and affiliation increased most rapidly in the poorest quintiles, from 4.3% in 1993 to 89.3% in 2013.
The health insurers (EPS) are bodies that individuals choose as insurers. At a minimum, they contract with providers to ensure availability of services listed in the Mandatory Health Plan, including health promotion, disease prevention, ambulatory and inpatient services, and rehabilitation. The insurers are expected to manage both clinical risk and financial risk, though few appeared to do so effectively at the time of the review. In 2013 there were 18 EPS in the contributory regime and 35 in the subsidised regime. Health service providers (IPS) compete in a mixed public-private market: in 2010 there were approximately 10,400 IPS — 9,277 private and 1,113 public — alongside 35,000 independent professionals.
Who pays, and what people pay
Compulsory contributions pooled nationally pay for the system. In the contributory regime, employees pay 4% of their income and employers 8.5% to FOSYGA; the subsidised regime is funded by government and municipal revenues and cross-subsidy transfers. Government and compulsory schemes accounted for 70% of health spending in 2023 (WHO Global Health Expenditure Database). What patients pay is low by regional standards: out-of-pocket spending was 14.6% of total health spending in 2023, and as coverage expanded, out-of-pocket expenditure fell rapidly — the OECD review records it at around 14% of total national health expenditure, one of the lowest levels in Latin America and lower than the OECD average of around 20%. Only 46% of people were satisfied with the availability of quality healthcare, against an OECD average of 64%.
What is free, and what is not
Free at the point of use: services in the Mandatory Health Plan (POS) for people affiliated to the SGSSS — an explicit list of inclusions covering health promotion, disease prevention, ambulatory and inpatient services, and rehabilitation. What is not free is the margin, and the gap is legal as much as financial: entitlements across the contributory and subsidised regimes are now equal in theory, but access remains a problem, as signalled by the rapid rise in appeals to the Constitutional Court for healthcare, known as tutelas — from 24,843 in 2000 to 117,746 in 2014, with the Court approving 81% of cases at the first hearing. In 2012 the Constitutional Court ruled that the benefits baskets for those in and out of formal employment should be equalised within a year. The workforce is thin: there are 2.5 practising doctors and 1.6 practising nurses per 1,000 population, against OECD averages of 3.9 and 9.2.
How it compares
Colombia spends 8.1% of GDP on health — below the OECD average of 9.3% — and $1,877 per person, below the OECD average of $5,967 (USD PPP, 2024). Its life expectancy of 77.5 years (2024) is 3.6 years below the OECD average of 81.1 years (OECD Health at a Glance 2025), and the fifth-lowest among the OECD profiles in this set, after Mexico (75.5 years in 2024), Latvia (75.6), Hungary (76.7) and Türkiye (77.3 years in 2022). Its distinguishing feature is the mortality behind the figures: avoidable mortality ran at 419 deaths per 100,000 people, the highest among the OECD profiles in this set, with preventable deaths at 304 and treatable deaths at 115 per 100,000 — and the capacity behind it is the thinnest in the OECD table, with 1.6 nurses per 1,000 people, the fewest in the OECD table, 2.5 doctors per 1,000, and only 6 CT, MRI and PET scanners per million people against an OECD average of 51. Compare countries side by side in the Health System Comparison tool, or read the other profiles in the country index.
Frequently asked questions
Is Colombian healthcare free?
People affiliated to the SGSSS are entitled to a package of services called the Mandatory Health Plan, with no bill at the point of use for services in the package — but access is uneven, and people appeal to the Constitutional Court for treatments outside the guaranteed basket.
What is the SGSSS?
The General System of Social Security in Health: the mandatory social health insurance system created by Law 100 of 1993, with a contributory regime for people in formal employment, a subsidised regime for people not in formal employment, and a much smaller Special Benefit Regime.
What are EPS and IPS?
EPS (Entidades Promotoras de Salud) are the health insurers people choose: they contract with providers and manage clinical and financial risk. IPS (Instituciones Prestadoras de Salud) are the health service providers — public and private hospitals, clinics and professionals — that deliver the care.