The year 2025 represented a critical point for the health system in Colombia. More than a period of definitive structural reforms, it was a year marked by deep financial tensions, unfinished political debates and health challenges associated with the environmental environment, which directly impacted the population. Health ceased to be an issueexclusively technical to become a daily concern for millions of people, reflected in access to services, medicines and timely care.

This article presents an overview of what happened in health during 2025, integrating economic, social, environmental and political aspects, and presents a forward-looking view2026.

A system under financial and operational pressure

During 2025, the Colombian health system faced sustained financial pressure, evidenced in liquidity problems, increased hospital portfolio and delays in payments to service providers [1]. Various hospiand clinics reported difficulties in sustaining their normal operation, which in some cases resulted in suspension of services, reduction of shifts, or delays in clinical procedures.

In response, the Government strengthened the direct rotation mechanism through the Administrator of the Resources of the General Security System Social in Health (ADRES), with the aim of ensuring that resources reach directly the health providing institutions (IPS) [2]. Although this measure made it possible to partially alleviate the cash flow of some lenders, different analyses agreed that the structural problem is not limited to the flow of resources, but includesthe inadequacy of the Unit of Payment by Capitation (UPC), weaknesses in the audit of accounts, historical accumulation of debts and lack of financial sustainability of the model [3].

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For citizens, these tensions were reflected in administrative delays, frequent changes in care networks and difficulties in continuously accessing treatments, even when they were formally covered by the system.

The political debate and the reform of thehealth

One of the most relevant events of 2025 was the collapse of the health reform in the Congress of the Republic, after several months of legislative discussion [4]. The project file kept the existing assurance model in force, although accompanied by administrative and regulatory adjustments.

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This result had a double effect. On the one hand, it prevented an immediate structural transformation of the system; on the other, it deepened regulatory uncertainty for EPS, IPS, supplierand users. The absence of clear definitions generated caution in investment decisions, contracting and expansion of services, in a context already marked by financial restrictions.

From the citizen perspective, the political debate produced attrition and mistrust, as the structural problems of the system persisted without a solutionclear, while public discourse remained highly polarized.

Companies in the health sector: impacts and rearrangements

During 2025, special surveillance and intervention measures continued on several EPS, accompanied by transfers of affiliates and reordering of care networks[5]. These decisions sought to protect the continuity of the service, but also generated operational overhead in the receiving IPS and complex adaptation processes for users.

Access to medicines was one of the most sensitive issues of the year. Although the health authorities stated that there was no general shortageat the national level [6], multiple journalistic reports and citizen testimonies evidenced persistent practical barriers, such as delays in deliveries, frequent changes of pharmaceutical operators, and extensive administrative processes [1]. This contrast made it clear that the nominal availability of drugs does not guarantee accesseffective and timely for the patient.

Social and Territorial Impact

Regional gaps in health continued inone of the main challenges of the system in 2025. While large cities concentrate infrastructure, human talent and technology, rural and dispersed areas face historical limitations in access and resolving capacity.

In contexts of financial stress, these inequalities tend to deepen. Public hospitals andin remote regions, they are often the first to be affected by late payments, compromising prevention programs, primary care and patient transport.it is important to note that approximately 75% of the health service delivery network in Colombia corresponds to the private sector, which implies that any financial or regulatory impact has a direct and significant impact on the actual availability of services for the population [5].

<span style="color: #800080;">Health and environment: an increasingly clear relationship

The year 2025 reaffirmed that environmental factors are key determinants of public health. Colombia faced major outbreaks of vector-borne diseases, such as dengue and yellow fever. The latter led to the declaration of a health emergencyand the implementation of vaccination campaigns in various regions of the country [7]. While these actions were necessary from a health point of view, the coverage results were below initial expectations, which evidenced limitations in access, logistics and adherence, especially in rural areas and difficult tocceso.

The National Institute of Health reported an active circulation of these events, associated with factors such as climate change, deforestation, population mobility and specific weather conditions [8]. In turn, the Institute of Hydrology, Meteorology and Environmental Studies reported La Niña-type climatic conditions, relevant tora the epidemiological behavior of several diseases [9]. These events reinforced the need to more effectively integrate health, environmental and territorial planning policies, understanding that prevention does not depend solely on the healthcare system.

Positives and learningsof 2025

Despite the difficulties, the year left some relevant learnings. There was greater public visibility and monitoring of the financial flows of the health system [2], as well as an increase in citizen and technical debate on the sustainability of the model. Recognition of the relationship was also strengthenedbetween health, environment and territory as a strategic axis of public health. However, these advances are still insufficient in the face of the magnitude of the structural challenges.

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Unresolved challenges and persistent errors

Among the main pending issues of the system are the lack of lasting political consensus, the insufficiency of the UPC compared to the current epidemiological profile, the structural problems of financing andaudit, administrative overhead for users and providers, and the persistence of regional inequalities. Without clear progress on these fronts, the system runs the risk of maintaining its formal operation, but with chronic failures in real and timely access to care.

Vision 2026: a scenario d

faced with 2026, the most likely scenarios point to a context of greater political polarization and deepening financial tensions, rather than stable continuity or consensual reform. If the problems of financial sustainability, adequacy of the UPC and transparency in theof the EPS intervened, the system could face greater operational risks, with a direct impact on the provider network – especially private – and on the user experience.

For citizens, some key indicators to follow will be the timely delivery of medicines, the stability of the hospital network and the capacity to respondin the face of health emergencies.

The year 2025 did not mean a definitive transformation of the Colombian health system, but it did reveal its structural fragilities. The challenge for 2026 will be to move towards technical decisions aimed at the financial sustainability of the system, the sufficiency of the UPC and transparency in themanagement of the EPS intervened, in order to guarantee effective, equitable and continuous access to health services.

References

1.  El País. (2025). The Petro Government clashes with the Comptroller’s Office over the New EPS crisis.
2. System Resource Administratorgeneral of Social Security in Health (ADRES). (2025). Reports on transfers and execution of resources of the health system.
3. Ministry of Health and Social Protection. (2025). Health sector budget execution report.
4. El País. (2025). Congress sinks health reform in Colombia again.
5. Superintendentnational Health Agency. (2025). Entities in special measure and intervention processes.
6. Administrator of the Resources of the General System of Social Security in Health (ADRES). (2025). Official statement on the availability of medicines in Colombia.
7. Ministry of Health and Social Protection. (2025). Resolution 6912025 – Health emergency due to yellow fever.
8. National Institute of Health. (2025). Weekly epidemiological bulletins.
9. Institute of Hydrology, Meteorology and Environmental Studies (IDEAM). (2025). Report of La Niña-type climatic conditions.