This study examines Colombias health spending from 2016 to 2020, focusing on areas for improving spending efficiency. The findings reveal that while Colombia's public health expenditure as a share of GDP aligns with the average of 42 comparator countries, its public spending as a share of total health expenditure is higher. Efficiency indicators suggest Colombia lags behind OECD countries in health outcomes per dollar spent, with potential to increase life expectancy by up to four years if spending efficiency matched the most effective systems.
Significant inefficiencies are observed in high-complexity care, particularly the overuse of expensive emergency services. Preventable hospitalizations, although not excessive compared to regional peers, still account for COP 1.6 trillion, representing 3% of public health expenditure and 17% of total hospitalization costs. Conditions such as cardiovascular disease, chronic renal disease, chronic obstructive pulmonary disease, diabetes, and certain cancers contribute disproportionately to spending. For example, cardiovascular disease alone accounts for 30% of spending on preventable hospitalizations and 50% of expenditures related to modifiable risks. Furthermore, 20% of total health spending is tied to preventable conditions linked to tobacco use, harmful alcohol consumption, physical inactivity, and unhealthy diets.
The study recommends transitioning toward an efficient primary health care model to alleviate reliance on emergency care and reduce preventable hospitalizations. Enhancing the quality and availability of primary care, particularly on weekends and non-working days, could significantly improve health outcomes. Identifying cost-effective technologies and care models for high-cost diseases could optimize resources and improve population health.
Colombia also faces challenges in managing drug expenditure, which constitutes 19% of total health spending well above comparator countries. Biological drugs alone account for 21-35% of this spending and are expected to grow due to non-communicable diseases and medical innovations. Current coverage policies allow patients to access any drug prescribed or mandated by courts, often without cost-benefit consideration. To address this, Colombia should implement strategies such as price regulation, centralized procurement, competitive tenders, and shared risk agreements, while advancing health technology assessments for decision-making.
Finally, institutionalizing evaluation and monitoring of health spending efficiency is critical. Developing a robust control panel of indicators to identify and address inefficiencies can support evidence-based policy design. Although Colombia has adequate data, it requires a more formalized strategy to monitor waste and enhance efficiency comprehensively. These measures are essential to ensure sustainable and effective health spending in the long term.