Colombia's General System of Social Security in Health (SGSSS)
- System and programme
It is Colombia's health insurance system, created by Law 100 of 1993: every resident must be enrolled with an EPS (health insurer).
What it is
The SGSSS is the health insurance model created by Law 100 of 1993. Everyone must enrol, in the contributory scheme if they can pay or in the subsidised scheme if they cannot. The EPS (insurers) organise and guarantee the services of the benefits plan and contract them with IPS (providers); the system pays them a fixed amount per enrollee, the UPC. The State directs, regulates and oversees through the Ministry of Health and Social Protection and the National Health Superintendency.
How it is organised
- Direction, oversight and control: Ministry of Health and Social Protection and National Health Superintendency (Supersalud).
- Administration and financing: EPS of both schemes, territorial health directorates and ADRES (which replaced the former Fosyga fund).
- Provision: public, private or mixed health service providers (IPS).
- Users: contributing enrollees, their beneficiaries and subsidised enrollees, with mechanisms for social participation.
- Territorial entities (departments, districts and municipalities): public health in their territory, subsidised enrolment and surveillance.
Worked example
- A made-up employee with a work contract enrols with an EPS in the contributory scheme and registers her 6-year-old son as a beneficiary.
- Her contribution is paid each month; the system pays the EPS one UPC for each of the 2 enrollees.
- The EPS contracts a network of IPS: the boy is seen at a low-complexity IPS in his municipality.
- If he needs a specialist, the EPS guarantees care at a higher-complexity IPS in its network.
- ADRES transfers the funds; Supersalud oversees that the EPS complies.
SGSSS actors and their main role
| Actor | Main role |
|---|---|
| Ministry of Health and Social Protection | Directs, regulates and sets policy and the benefits plan |
| National Health Superintendency | Inspection, oversight and control; judicial functions in some disputes |
| ADRES | Manages the system's funds and recognises and pays the UPC |
| EPS | Enrols people, manages risk and guarantees services to its enrollees |
| IPS | Provides health services |
| Territorial entities | Public health, surveillance and management of the subsidised scheme in their territory |
Markers
- SGSSS
- Law 100
- EPS
- IPS
- ADRES
- Supersalud
- UPC
In practice
- Before referring a patient it helps to know their EPS, their scheme and the contracted network.
- Initial emergency care is mandatory for every IPS and needs no contract or prior order (Law 100, article 168).
Reference norms
- Political Constitution of 1991, article 49: health care is a public service under the responsibility of the State.
- Law 100 of 1993: creates the SGSSS (articles 152 to 157 on purpose, members, features and participants).
- Law 1122 of 2007 and Law 1438 of 2011: adjustments to the system, insurance, primary care and networks.
- Law 1751 of 2015 (statutory): health as a fundamental right.
- Law 1753 of 2015, article 66: creates ADRES. Decree 780 of 2016: the single regulatory decree of the health sector.
Test yourself
Think of the answer, then tap the question to see it.
Which law created the General System of Social Security in Health?
Law 100 of 1993, in its second book.
What are the two enrolment schemes of the SGSSS?
The contributory scheme, for people able to pay, and the subsidised scheme, for people unable to pay.
Which entity manages the system's funds and pays the UPC to the EPS?
ADRES, created by article 66 of Law 1753 of 2015.
Which entity carries out inspection, oversight and control of EPS and IPS?
The National Health Superintendency (Supersalud).
Connections
Educational content on epidemiological and statistical methods; the examples use made-up numbers to teach the calculation. Not a clinical or legal guide: current Colombian rules are in the official sources.
Sources: Ley 100 de 1993 (Departamento Administrativo de la Función Pública, Colombia (Gestor Normativo), 1993); Ley 1122 de 2007 (Departamento Administrativo de la Función Pública, Colombia (Gestor Normativo), 2007); Ley 1753 de 2015 (Departamento Administrativo de la Función Pública, Colombia (Gestor Normativo), 2015); ¿Qué es la ADRES? | ADRES (Administradora de los Recursos del Sistema General de Seguridad Social en Salud (ADRES), 2026).
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Representative model, for educational purposes only.