From Few to Many: Ten Years of Health Insurance Expansion in Colombia

Cueto, Enriqueta;
López, Juan Gonzalo;
Castaño, Ramón A.;
Pardo, Renata;
Alfonso, Eduardo Andrés;
López, Álvaro;
Díaz, Beatriz Yadira;
Escobar, María Luisa;
Arango, Carlos H.;
Ruiz Gómez, Fernando;
Jan 2009
Giedion, Úrsula; Glassman, Amanda; Giuffrida, Antonio; Escobar, María Luisa
From Few to Many is the first comprehensive look at Colombia's 1993 health system reforms. It describes the implementation of universal health insurance, including a subsidized system for the poor, and examines the impact of this and other reforms during a time when Colombia experienced crushing recession and internal conflict that displaced half a million people. Prior to the reforms, a quarter of the Colombian population had health insurance. Subsidies failed to reach the poor, who were vulnerable to catastrophic financial consequences of illness. Yet by 2008, 85 percent of the population benefited from health insurance. From Few to Many describes the challenges and benefits of implementing social health reforms in a developing country, exploring health care financing, institutional reform, the effects of political will on health care, and more. The reforms have provided important lessons not only for continued reform in Colombia, but also for other nations facing similar challenges.