Did you know that Colombia was recently in the top 4 countries with the best health care in the world (source)? And that in the year 2000, the country was named number 22 by the World Health Organization with the best healthcare system worldwide? (source) And thus left behind Germany, Canada, Australia and the U.S., among others? After almost 2.5 years of living in Bogotá, I have experienced firsthand how healthcare works in Colombia, and have already used more healthcare than during my 29 years in the Netherlands. In this article, I briefly explain the healthcare system and my own experiences. The healthcare system in Colombia is quite complex. Since I am far from knowing everything about it, a whole book could be written about it and there are many differences between health insurance policies, in this article I will keep it short and describe my experiences.
What is the health care system like in Colombia?
What does the healthcare system consist of?
Actually, the Colombian healthcare system is quite similar to the Dutch one. The Colombian health system consists of three entities:
- Government: the coordinating body for management and control.
- Insurers: private institutions that provide insurance for the population. These include the Entidades Promotoras de Salud (EPS; health insurance companies) and the Administradoras de Riesgos Laborales (ARL; insurance for risks at work).
- The healthcare providers: the Instituciones Prestadoras de Salud (IPS; healthcare institutions and healthcare providers), such as hospitals, clinics, laboratories, doctors, nurses and ambulances.
As in the Netherlands, in Colombia it is mandatory to register with an EPS (a health insurance company) for basic insurance. The insurer then organizes and provides health services within the Plan Obligatorio de Salud (POS; the mandatory care plan of consultations, treatments, tests, medications, etc.). There are two ways to insure the population:
- Through a monthly contribution by the insured: this is for all employees and employers who are able to pay a fixed amount each month for health insurance and retirement.
- Subsidized: for poor people who cannot pay monthly for basic insurance, insurance is subsidized. These people do need to register with an EPS to receive care.
Not all care is covered by basic insurance, such as plastic surgery, prosthetics and infertility treatments.
How and how much do you pay for health insurance?
As in the Netherlands, you choose your health insurance company. You provide this information to your employer after which the monthly fee is automatically debited. Self-employed people, like myself, pay their own expenses to the health insurance company and pension each month via the Internet. This is very easy through a special website where you can transfer everything at once. Via mail I then get the proof of payment which I then have to give to my employer to get my salary paid. How much you pay depends on insurance and salary. I myself pay about 72 euros per month for just basic insurance.
The deductible as you know in the Netherlands does not exist in Colombia, but own contributions for example for consultations and medication do. Whether you have to pay extra depends on the type of care and whether you have supplemental insurance.
The supplementary insurance
There are two complementary insurances available in Colombia: prepagada (prepaid care) and the plan complementario (supplementary insurance). People who have prepaid insurance have the best of the best. This is because with it you get the best service, you get to go to the best hospitals and clinics, the doctor comes to your home and you can see a medical specialist directly. However, this insurance is quite expensive and therefore only available to people with a lot of money. The complementario plan is similar to the supplementary insurance in the Netherlands. Only in the Netherlands do you get reimbursed for more services with supplemental insurance, while here you receive better care in addition to more reimbursement. For example, with supplemental insurance for dermatology, you can see a dermatologist more easily and quickly, and you don’t have to pay extra for a consultation or surgery. In addition, for example, you can get a single room during hospitalization, and more extras like that.
Hospitals in Colombia
Colombia has many hospitals and clinics, both private and public. Bogotá alone has 36 hospitals and many more clinics and laboratories. Hospitals are classified by service they provide or level of complexity. There are many excellent hospitals and clinics, especially in major cities. Half of Latin America’s 43 top hospitals are located in Colombia.
In Colombia, it is also possible to pay for private care. For example, if you don’t want to wait for a doctor’s appointment or want results of blood tests in advance. You can also make an appointment with a medical specialist privately. Of course, you then pay for this yourself. The cost depends on the type of care and the hospital or clinic: in fact, some hospitals are more expensive than others. In general, healthcare in Colombia is many times cheaper than in the Netherlands, but poorly affordable for people with low (or no) salaries.
What struck me about health care in Colombia
Your own medical record
Now in the Netherlands you can always request your medical records, but usually when you go to a doctor they simply tell you in easy language what the results are. Exactly what that outcome then looks like you don’t know. The first thing I noticed when I went to the doctor in Colombia was that you always get verbatim what the results are or what was discussed. Even X-rays you get to take home. So I have my entire medical record at home. I can always show this to Jimmy if something is not clear to me and take it to a doctor. So convenient!
Find a doctor’s appointment at 8 a.m. early? Here it is quite normal to be in the consultation room or on the operating table by 7 a.m.. I even had two appointments with a specialist at 6:30 in the morning.
Easy to obtain medication
In the Netherlands you need a prescription for many medicines, in Colombia much can be bought simply at the corner drugstore. For example, you can order antibiotics from home without a prescription, and I no longer have to get a follow-up prescription for my allergy medication. The price of medication depends on whether it is generic or commercial. Commercial is always much more expensive than generic, and can save tens of thousands of pesos. I always buy medication generically. An example: for 10 pills of cetirizine I pay generically 3,500 pesos (1.20 euros), commercially I can add at least 10,000 pesos to this. Now of course it is quite dangerous that so many medications are freely available, especially the antibiotics, but also quite convenient. In the Netherlands, you really have to go to the family doctor first for everything.
Bizarre working hours doctors
Some time ago I wrote here an article about the work of Jimmy, who has now been in training as an anesthesiologist for less than a year. Working hours that regularly extend to as many as four days nonstop in a row due to work at multiple hospitals are no exception. All physicians work regular 24-hour shifts. Colombians are known as hard workers, which is good, of course, but the idea of an anesthesiologist at my bedside who has already put in 20 hours is a little scary to me.
Before any treatment can take place, the referral must be authorized for that purpose. So if you need surgery, first you have to take the bill that says what surgery you should get to an insurance general center to get a stamp for approval. You will be given information about where to go for surgery, and only then can you make an appointment. I myself have had to do this several times, and for that one stamp I always have to travel all the way to the other side of town.
Colombians complain a lot about their health care
I have heard many stories from Colombians, about failing care, things that are difficult to arrange, that it all takes so long, that the family doctor does not want to refer to a specialist and about disorganization. I myself have experienced just the opposite, and I know many people who are very satisfied, but it is certain that there is still a lot of room for improvement.
Good care depends on how much money you have
The quality of care depends very much on how much money you have. Because even though poor people also have access to care, for them everything often takes longer and they cannot afford medication or treatments. Health care in Colombia is extremely good, but not if you have little money.
For everything to another place
At SURA, I have to go elsewhere for everything. So a meeting with that medical specialist takes place in that hospital, for the biopsy I have to go to that clinic, the family doctor is there again, for the authorization I have to go to the other side of town, and the surgery is in yet another place. This way I have seen the inside of many clinics and it is always a surprise where to go.
What is my experience? Am I more satisfied with care in the Netherlands or in Colombia?
Honestly: I didn’t think healthcare in Colombia was that good! In the Netherlands, I regularly had frequent occasions when I was not happy at all with the family doctor, because he did not want to look further into where the symptoms came from or I was not allowed to have an examination which I wanted. Here everything is much better figured out and acted on more quickly. In addition, I find it immensely gratifying to just get the whole results to take home. After all, this leaves you in no doubt about what the doctor said and what exactly you have: after all, it is written down in detail. I brought my medical records from the Netherlands, but there is really literally nothing to take from them. Several times I have been amazed at how hugely luxurious some clinics or hospitals are. Up until now, I have also always been helped very quickly, referred well and allowed to have tests done for which they considered me too young in the Netherlands. Despite the areas for improvement, I am definitely more satisfied with health care in Colombia than in the Netherlands! Nevertheless, this certainly does not apply to everyone, and the poorer population in particular would be better off in Dutch care.