Colombia votes for new president with healthcare system on verge of collapse as main concern
The cross-spectrum diagnosis agrees on the gravity of the situation, but the causes divide the political spectrum
Colombia will hold on Sunday 31 May the first round of the presidential elections that will determine the succession of President Gustavo Petro for the 2026-2030 term, with an electoral roll of 41,287,084 voters and healthcare emerging as the electorate’s main concern, according to opinion polls. The national health system is going through its most severe crisis in decades: pharmacies are denying medications, hospitals are closing services, and specialist appointments are indefinitely postponed. A possible runoff would be held on 21 June if none of the fourteen candidates surpasses 50% of the vote.
A survey by the Guarumo firm published in February placed healthcare as the country’s most serious problem for 25% of citizens, above insecurity (15.9%), corruption (15.4%), and the cost of living (11.1%). A second survey by the Centro Nacional de Consultoría released in early May recorded that 37.1% consider that healthcare should be the main focus of the next president. Patient petitions, complaints, and claims before the Superintendency of Health rose from 915,000 in 2021 to 2.1 million in 2025, while tutela actions for violation of the right to healthcare grew from 92,000 to 313,000 in the same period, according to the Constitutional Court.
The cross-spectrum diagnosis agrees on the gravity of the situation, but the causes divide the political spectrum. The Petro government and its allies attribute the deterioration to the corruption of the Entidades Promotoras de Salud, the private and public insurers operating as intermediaries between the state and medical providers since the reform of the 1990s. The opposition argues instead that the crisis is the result of the deliberate defunding of the system driven by the executive. The Constitutional Court ordered in early 2025 the adjustment of the Capitation Payment Unit —the amount the state pays the EPS for each affiliate—, a decision the government ignored arguing that its own calculations are correct. The aggregate operational results of the insurers shifted from a deficit of 1.5 trillion pesos in 2021 to 8.7 trillion in 2025, around USD 2.4 billion.
Former president Petro, whose legislative reform to eliminate the EPS sank twice in Congress, opted for the administrative intervention of around a dozen insurers and the redistribution of resources toward public hospital infrastructure. The strategy has yielded few visible results, with recurring corruption complaints against the very interveners designated. Nueva EPS, the country’s largest with 11.5 million affiliates and under state intervention since 2024, has not filed financial balances since 2023.
The five leading candidates —leftist senator Iván Cepeda, of the ruling Pacto Histórico, Petro’s political heir; far-right Abelardo de la Espriella, of the National Salvation Movement; right-wing senator Paloma Valencia, of the uribista Centro Democrático; centre-left Sergio Fajardo, of Dignidad y Compromiso; and centre-left Claudia López, of the Imparables movement and former Mayor of Bogotá— have incorporated healthcare into their platforms, although with proposals often limited to general slogans. Cepeda avoids the topic and emphasizes the need to pass Petro’s reform. The other contenders promise financial rescues without detailing the source of funding. López proposed reviewing the benefits covered by the system, a measure analysts consider electorally risky.