Article: The Colombia ConundrumPMLiVE #Research_PartnershipJanuary 24, 2020
Colombia is firmly establishing itself on the radar of pharmaceutical companies as a ‘second tier’ Latin American market, given its growing proportion of middle classes and rapid economic growth, which in recent years has consistently outperformed the continental average.
No wonder, therefore, that Colombia is increasingly catching the eye of pharmaceutical companies wishing to leverage this dynamic and growing market.
Today, Colombia’s healthcare system broadly follows the Bismarck model, based on insurance systems funded by employers and employees through salaried contributions.
This covers approximately 40% of Colombians – those in formal employment and some pensioners – who are legally obliged to make salaried contributions to the scheme.
The EPS-S is a subsidized scheme for those outside of formal employment.
On top of these is privately funded healthcare, which often involves ‘top up’ plans offered by EPS in addition to the basic schemes, expanding benefit entitlements and enabling access to leading private facilities.
An essential drug list (‘POS – Plan Obligatorio de Salud’) is drawn up to cover the medicines to which Colombians are entitled under the EPS.
Another special government scheme, FOSYGA, has been set up to directly reimburse the healthcare providers for certain high cost treatments not included on this list.
Given ‘right to healthcare’ is listed as a fundamental right in Colombia’s constitution, patients can sue their healthcare providers if they refuse to cover certain treatments to which they feel they are entitled.
In a move to combat corruption, the EPS are set to be replaced by ‘health consultancies’, which no longer manage funds and simply serve to provide an intermediary function linking government and patients; there are plans for funding to be managed centrally under a governmental body, ‘Salud Mia’ (my health).While it remains to be seen what will come of these reforms, at least in the medium-term, the opportunity for branded, innovative pharmaceuticals is focused in the private sector, or at least the EPS-C.
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