By insuring more than 80 percent of its population, Colombia provides a valuable opportunity to gather evidence on a hotly debated health policy issue. Results from three studies evaluating the impact of universal health insurance in Colombia show that it has greatly increased access to and use of health services, even those that are free for all, and has reduced the incidence of catastrophic health spending. The impact has been more dramatic among those most vulnerable to health shocks: those living in rural areas, the poorest, and the self-employed.

The results of providing health insurance for all in a middle-income country.

THE POSITIVE EFFECT of health insurance coverage on the use of medical care has been widely demonstrated and is generally accepted in the developed world.1 However, little evidence is available on the impact of health insurance in the developing world.

Hoping to reap the benefits of health insurance for its population, in 1993 Colombia approved a universal health insurance scheme (Law 100) whereby all citizens, irrespective of their ability to pay, are entitled to a comprehensive health benefit package. In Colombia’s system of universal health insurance, people participate in one of two regimes depending on income: the Contributory Regime (CR), which covers workers and their families with monthly incomes above a minimum monthly amount (approximately US$170 per month), and the Subsidized Regime (SR), which covers those identified as being poor through a proxy means test.