Page 68 - Genomic Medicine in Emerging Economies

Health Care System in Colombia 57

However, the growth of the system has been uneven, and it is estimated that
between 2002 and 2008 the subsidized system grew 2.8 times more than the
contributive system (Calderón Agudelo et al., 2011). The Colombian Consti-
tutional Court decided to adjust equally the benefits plan (POS) for both sys-
tems, based on the principle of equality. Therefore, health expenditure went
from 5.9% in 2000 to 7.2% of GDP in 2014, putting the Colombian health
system at risk (World Bank, n.d.).
Since health care resources in the country are limited, genetic disorders have
not been a public health priority. The introduction of genetic diagnostic tests in
clinical care was slowed down by not being included in the Mandatory Health
Plan (POS) until recent years (Resolución 5592 Dic de 2015) (MSPS, 2015).
However, since these tests remain very expensive and are mainly performed
outside the country, insurance companies usually deny these tests to most
patients even if they are obliged to cover their costs. Then, only patients, who
demand testing through legal action for “protection of the right to health and
life,” get the tests paid for by the insurance companies, which eventually are
reimbursed by the government. This increases the costs for patients and for the
health care system and delays appropriate diagnosis and management. For-
tunately, this is currently changing, and genetic tests are being progressively
included in Colombian management guidelines for different diseases and
are therefore more often financed by the health care system. As mentioned
before, one of the fields with a more accelerated advance in genomic medi-
cine in Columbia is oncology, because of the global movement toward a more
personalized treatment based on genomic profiles of tumors and the devel-
opment of targeted cancer therapies. Therefore cancer patients are starting
to have more access and benefit from these approaches. However, huge gaps
still exist between the subsidized and the contributive systems. Patients in the
subsidized system generally receive less and a worse quality of health care,
reflected by barriers and delayed access to medical care and late diagnosis and
treatment. In the contributive system, there are also great differences among
insurance companies (EPS) in access and quality of care. A study performed in
the IDC, showed the shocking difference in outcome of breast cancer patients
according to the type of insurance held by patients, subsidized or contributive,
and even among insurance companies within the contributive regime (EPS)
(García et al., 2017). Patients from the contributive regime had a mortality
rate of 10% during the follow-up period, and 12% had metastasis or recur-
rence, compared with a mortality rate of 23% and metastasis or recurrence in
20.6% of patients from the subsidized regime (P < 0.05) (García et al., 2017).
The time of access to oncologic treatment was twice the time in the subsidized
regime (112 days) compared with the contributive regime (52 days), which
had an important impact on the prognosis of the patients (García et al., 2017).
This illustrates the disparities in health care according to the socioeconomic
level and the type of regime.