As Colombia heads toward a new presidential election, health care has become one of the country’s most urgent and politically charged issues. This is no longer just a policy debate or an ideological dispute over how the system should be organized. For millions of Colombians, health care today means delayed authorizations, medications that never arrive, specialists who are nearly impossible to access, and families forced to navigate a maze of paperwork while trying to manage serious illness.
The crisis cannot be reduced to a single administrative or budgetary failure. What Colombia is facing is the cumulative exhaustion of a system weighed down by debt, weak coordination, regulatory delays, access barriers, and years of political fights that often seem more focused on defending or dismantling the model than on solving the patient’s immediate reality. Several EPS insurers have also been operating under structural financial stress, with liabilities growing faster than their ability to respond.
That raises a difficult but unavoidable question: How did Colombia reach a point where getting sick often means not just confronting a diagnosis, but also surviving a bureaucratic obstacle course to receive treatment? At what point did the right to health care begin to feel less like a guarantee and more like a test of endurance?
One of the central fault lines in this crisis is the Capitation Payment Unit (UPC), the amount the state allocates per person enrolled in the system. Critics across the sector argue that it no longer reflects the true cost of care, especially as Colombia’s population ages and chronic disease becomes more common. On top of that financing strain, two other structural bottlenecks continue to define the patient experience: delayed access to medications and the system’s inability to absorb innovation quickly enough.
That diagnosis matters because the country is not just dealing with a shortage of money. It is dealing with a shortage of technical capacity, regulatory speed, and institutional responsiveness. Even when new treatments exist, they often reach Colombian patients too late. Even when coverage exists on paper, access in practice remains inconsistent and deeply unequal.
That is why the priorities recently emphasized by Afidro (Colombia’s main association of research-based pharmaceutical companies, representing international labs that develop innovative medicines and focuses on promoting access to new treatments) and Proesa (an academic research center that analyzes Colombia’s health system from an economical and technical perspective to help guide decision-making in the sector) offer a useful framework for judging what the candidates are actually proposing.
Their three main concerns are straightforward: Ensure adequate financing, remove regulatory barriers that delay access to medications, and make it easier for innovative technologies to enter the system based on their real value. Those priorities offer a much more grounded way to measure campaign promises than slogans alone.
Between structural reform and defending the current model: Ivan Cepeda, Paloma Valencia, and Roy Barreras
If this campaign reveals anything, it is that health care is not just a technical issue; it is a clash of different visions for the state itself.
In the case of Iván Cepeda, his proposal starts from the idea that Colombia’s health care system is not simply malfunctioning, but structurally broken. His position leans toward a deep reform, with stronger state leadership, greater emphasis on prevention and primary care, and a reduced role for the EPS insurers as financial intermediaries.
That diagnosis resonates with real weaknesses in the current system: fragmented care, major disparities between regions, weak continuity for complex treatments, and insufficient investment in prevention and mental health.
Still, the biggest question surrounding that approach is practical rather than ideological: how do you fundamentally transform the system without making an already unstable situation even worse in the short term? Cepeda speaks to the need for change, but his proposal remains less precise when it comes to the immediate challenges patients are facing right now, especially faster access to medications and more agile adoption of innovation.
So the real question is not simply whether Colombia needs a major health reform — because many signs suggest that it does — but whether the country currently has the institutional and operational capacity to carry out that transformation without deepening the crisis in the process. Can Colombia afford a sweeping overhaul if it cannot first guarantee that patients will not absorb the cost of that transition?
At the other end of the spectrum is Paloma Valencia, whose approach is more aligned with preserving the current insurance-based model while making it more financially viable. Her diagnosis centers on a funding problem, and her response focuses on debt stabilization, stronger financial discipline, and recalibrating the way the system is funded. That includes proposals such as debt securitization, revising the financing structure, increasing contributions, and introducing a risk-adjusted UPC based on patient profiles.
That places her closer to one of the most pressing needs identified by technical observers: Colombia’s financing formulas no longer reflect the actual burden of disease or the cost of care. Valencia also offers more concrete proposals around medications and innovation than some of her rivals, including reorganizing Invima, Colombia’s regulatory agency, improving pharmaceutical supply, and promoting remote diagnostics, digital health infrastructure, and artificial intelligence in service delivery.
Her proposal suggests a more modern understanding of health care, one that includes not just hospitals and insurers, but also data systems, regulatory efficiency, and technological capacity. Yet even if more money is injected into the system and its formulas are corrected, another uncomfortable question remains: Is it enough to stabilize the system financially if the patient experience itself has already become intolerable for so many people? Can a model survive simply because it still functions on paper, even as it is losing social legitimacy in practice?
Roy Barreras, meanwhile, occupies a more pragmatic middle ground. His approach is less about tearing down the current structure and more about preventing it from collapsing further. His proposals emphasize restoring the insurance system through audits, tighter use of resources, and operational corrections designed to keep clinics and hospitals afloat. He also supports managed purchasing agreements, home delivery of medications, and direct payments to pharmaceutical companies to reduce bottlenecks in access.
Barreras also brings in an issue that several other candidates touch only lightly: domestic drug production and patent negotiations, which connect his platform to broader debates about health sovereignty and supply resilience. His proposal has a clear logic in a moment of institutional fragility: before building a new system, Colombia may first need to stop the current one from unraveling.
But that raises its own difficult question: does Colombia need a bold reinvention of the health care system right now, or first and foremost a serious stabilization strategy? And how do you stabilize a broken system without quietly accepting today’s precarious conditions as the new normal?
Health care as a management and capacity problem: Claudia Lopez and Sergio Fajardo
In the political center, Claudia López and Sergio Fajardo represent a less ideological and more managerial approach. Their proposals are built around a premise that resonates with many exhausted voters: Colombia does not just need a philosophical debate about health care, it needs a system that actually works better.
For Claudia López, that means trying to rescue the system operationally without dismantling it entirely. Her proposal includes fresh funding, a hospital rescue fund, and the defense of a mixed public-private model. She also supports a new independent actuarial study to recalculate financing based on current demographic and epidemiological realities.
That focus speaks directly to one of the system’s biggest blind spots: decisions have too often been made with outdated or incomplete information. López also addresses something much more tangible for patients by promising timely access to medications and treatments without unnecessary barriers. Her platform becomes more distinctive when it moves into technology, where she supports interoperability, a single digital medical record, and a more integrated health information system.
That diagnosis is not trivial. Part of the patient’s suffering today is not just caused by a lack of resources, but by the disorganization of information. A system in which people must repeatedly submit their records, exams, and requests is not just inefficient; it is profoundly unequal.
Still, that raises another key question: how prepared is the Colombian state to carry out a digital transformation of that scale without leaving behind the regions and communities that already face the greatest access barriers? How can innovation be implemented without simply reinforcing existing inequalities?
Sergio Fajardo, by contrast, offers perhaps the most explicitly technocratic proposal of the field. He has suggested creating a “presidential command center” for health care from day one, signaling that he views the crisis as requiring top-level political coordination rather than fragmented administrative responses. His platform includes adjusting the UPC, restructuring sector debt, and conducting audits of EPS insurers to improve control over how resources are used.
That makes his proposal especially aligned with the need for better financial governance. On medications, he proposes stronger monitoring of shortages and failures in access, while on innovation, he supports domestic production of high-tech medications and stronger use of health information systems and data management.
His strength lies in recognizing that the future of the system depends not just on how much the state spends, but on how intelligently it governs. But his challenge is also clear: in a country where patient suffering is experienced in delays, paperwork, and uncertainty, many voters may wonder whether technical competence alone is enough. Can good management restore trust in a system that, for many families, no longer feels trustworthy at all?
Abelardo de La Espriella and the politics of urgency
Abelardo De La Espriella has built much of his public appeal around a politics of confrontation and urgency, and that carries over into his health care proposal. He describes the current situation as a “humanitarian health care crisis” and proposes a 10 trillion-peso (roughly US$ 2.4 million) emergency plan during his first 90 days to stabilize the system financially. He also supports adjusting the real value of the UPC and offering grace periods for debt repayment.
Taking this into account, and as Jose Manuel Restrepo — Abelardo de La Espriella’s vice-presidential running mate — told Colombia One, there is still an outstanding debt from the past, “which I estimate at around 40 trillion pesos (about US$11 billion). This will require major efforts, including measures that this government had proposed but was never able to implement — such as primary health care centers focused on promotion and prevention.”
This is an issue that is taking a toll on Colombia’s health care system, and candidate De La Espriella appears to be well aware of this as one of the major challenges in addressing the health care sector’s crisis in Colombia.
Politically, his message has an obvious appeal. There is a broad public appetite for speed, not just diagnosis. After years of delays, shortages, and institutional deterioration, many voters are drawn to proposals that promise immediate action rather than long-term restructuring.
De La Espriella also links that emergency approach to access, arguing that it would help normalize medication delivery and unlock payments across the system. On innovation, he points to telemedicine, a single digital health record, and artificial intelligence to improve appointment scheduling and treatment logistics.
Those tools do address real bottlenecks. Colombia does need more telemedicine, better digital traceability, and stronger system coordination. But the deeper question remains whether this is a structural proposal or simply an emergency intervention.
Can a short-term financial shock solve a problem that has been building for years through regulatory delays, institutional weakness, and technical deficits? Or is it simply a temporary release valve for a much deeper crisis?
What the system actually needs and why many campaign promises still fall short
Measured against the real needs of Colombia’s health care system, the most honest conclusion is that no candidate fully captures the whole problem, even if several do identify important parts of it. Some speak convincingly about structural reform but remain vague on regulation, innovation, or implementation.
Others offer stronger financial diagnoses but less clarity on political feasibility and territorial equity. Some lean heavily on management and technology but still need to prove that those tools can function in a system as unequal and fragmented as Colombia’s.
What is clear is that the system needs more than rhetoric. It needs financing formulas grounded in reality, a stronger and faster regulatory state, and a more modern understanding of what health care access actually means. That includes better data, a more agile Invima, more reliable medication supply, and the ability to incorporate innovation not as a luxury, but as a practical tool for improving care and reducing long-term costs.
But beyond all of that, Colombia also needs something more basic and more political: a health care debate that is less trapped in slogans and more rooted in the lived experience of patients.
Because if the discussion remains stuck between those who want to tear everything down and those who want to defend the current system, almost by inertia, the country risks continuing to orbit around the conflict without resolving what matters most.
In the end, this election should not be judged only by who delivers the sharpest criticism or the strongest campaign rhetoric. It should be judged by who is willing to confront the complexity of the problem without selling shortcuts.
Because if health care remains one of the greatest everyday fears for millions of Colombians, then the real electoral question is no longer ideological: Who can actually make the system work for people again? And how much longer can the country afford to wait before this crisis stops being manageable and becomes something even deeper?
That, ultimately, is the standard by which every health care proposal in this campaign should be measured. Not by how well it performs in a debate, nor by how neatly it fits into a political ideology, but by a much simpler and much more human question: If they become president, will they make getting sick in Colombia feel less like a bureaucratic punishment and more like a situation met with dignity, timely care, and less fear?