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Colombia 2018 | HEALTH & EDUCATION | REVIEW: HEALTH

Colombia maintains its place as the best public health system in Latin America, according to the WHO.

With continued success throughout 2017 in decreasing infant mortality, adolescent pregnancy, and chronic malnutrition, as well as boosting vaccination rates for diphtheria, whooping cough, tetanus, hepatitis B, influenza B, measles, mumps, and rubella, Colombia made sizable strides in retaining its place at the top of the public health sector in Latin America. According to the latest figures from WHO, Colombia ranked first in Latin America and 22nd in the world, a spot below Belgium and one ahead of Sweden.

A pioneer in the creation of proprietary health accreditation systems, Colombia's health system has made important recent advances such as the Hakim valve, a device for managing brain diseases, and measurable gains in medical services, which have not gone unnoticed. Of the 10 best hospitals and clinics in Latin America measured by América Economía, four are in Colombia—Fundación Santa Fe, fourth; Fundación Valle del Lili, seventh; Fundación Cardioinfantil, eighth; and Cardiovascular de Colombia, ninth. This is part of the reason why medical tourism from the US and Canada has soared in recent years; another is the country's highly decentralized system that encourages competition between different sectors and geographic poles.
However, much of the credit also must go to the state. With spending on health benefits up nearly 8% in 2018, from COP746 to 804 billion, the Ministry of Health and Social Protection is fighting hard to guarantee that every Colombian has access to quality universal healthcare. The 2018 budget covers 32 procedures and 78 medications, with a particular focus on forming the public's first line of defense against HIV, cancer, constipation, migraines, Alzheimer's, and pulmonary arterial hypertension, and boosting funding for radiotherapy, endoscopies, and ostomies. As part of this budget, premiums have also been increased for children under one, elders over 70, and women between 19 and 44.

The government also worked hard to streamline the sector and rid it of inefficient and corrupt conglomerates. Major insurance and healthcare providers Caprecom EPS and Saludcoop EPS, once the largest healthcare provider in the country, were finally liquidated after it came to light Saludcoop had carried out the largest fraud in Colombian history, the embezzlement of some USD300 million of public funds. Handing its control over to Cafesalud, Saludcoop's 37,000 employees were spared and its 1.5 billion pesos of outstanding debt paid down from the subsequent COP1.2 billion sale of Cafesalud.

The state also unveiled its Integral Healthcare Model (MIAS) for the first time in 2017, a vast program designed to cover Colombians from the country's most disparate regions. Apart from getting successfully off the ground in Bogotá, Medellín, Barranquilla, Ibagué, Risaralda, Cauca, Guainía, Chocó, and La Guajira, it was also rolled out among members of the police and armed forces and saw its biggest success in reducing maternal mortality rates in Guainía. MIAS also helped the country defeat the Zika epidemic with fewer than 100,000 cases, far less than many predicted would occur and a fraction of the 650,000 that surfaced in Brazil.

There were also several major victories in preventative medicine, such as the reduction in the use of tobacco from 12.9% to 8.3% of the population between 2013-2017 and the passage of a new law limiting the content of sodium, calories, sugar, and trans and saturated fat. As part of the state's monumental effort to integrate former combatants into society, the Ministry of Health managed to incorporate 10,257 ex-combatants into its subsidized healthcare system in 2017, a huge step forward.
To be sure, chronic challenges remain. Corruption and embezzlement continued to plague the country's universal healthcare system, with USD160 million disappearing in 2017 alone at the hands of at least 18 criminal networks. While ghost patients are the most recurring source of fraudulent claims, the manipulation of medical records and hiring of nonexistent employees are also prevalent means by which “healthcare mafias" drain the public purse. Another persistent strain on the system has been recent increasing flood of uninsured Venezuelan migrants seeking medical assistance in border regions.

If it plays its cards right, however, the state is hoping to make up for these losses, if not annul them, through massive gains in the medical cannabis sector. Having set its eyes on capturing 45% of the global medicinal marijuana market in 2018, in September 2017 the government began handing out the first licenses to grow, process, and export marijuana for medicinal uses. So far, 33 companies have been approved, among them Khiron Life Sciences Corp., which is focused on developing strong relationships with the medical community and set up the first cannabis guild, and PharmaCielo Ltd., which has begun planting psychoactive and non-psychoactive strains at a nursery in Antioquia. Even if it only reaches a fraction of its ambitious target, in a market estimated to be worth USD31.6 billion by 2021, the trickle down from medicinal cannabis could go far.