The subsidised scheme
- System and programme
It is enrolment for poor and vulnerable people unable to pay: the State pays their insurance with public and solidarity funds.
What it is
The subsidised scheme brings into the SGSSS people unable to pay, whose contribution is fully or partly funded from tax or solidarity resources. Beneficiaries are identified with targeting tools such as SISBÉN and census lists of special populations, and enrolment is managed by territorial entities with the EPS. Enrollees are entitled to the benefits plan and keep access to care anywhere in the country (portability).
How it is organised
- Territorial entities identify eligible people and promote their enrolment.
- EPS of the subsidised scheme enrol people and guarantee the benefits plan through the network they contract.
- ADRES recognises the subsidised UPC to the EPS and can pay providers directly.
- Special populations: people who, because of vulnerability, marginalisation, discrimination or manifest weakness, must belong to the subsidised scheme; many are identified through census lists.
Worked example
- A made-up farmer with no fixed income, his wife and 2 children are classified as poor by SISBÉN in their municipality.
- The health secretariat checks that they are eligible and the family enrols with an EPS of the subsidised scheme.
- All 4 receive the benefits plan; ADRES pays the EPS one subsidised UPC for each of them.
- If he travels to another city and falls ill, portability guarantees care outside his municipality.
- If he gets a formal job, he moves to the contributory scheme through mobility, without changing EPS.
Contributory versus subsidised
| Feature | Contributory | Subsidised |
|---|---|---|
| Who | People able to pay | Poor and vulnerable people unable to pay |
| How it is funded | Contributions of enrollees and employers | Tax and solidarity resources |
| How people are identified | Employment, pension or income | SISBÉN and lists of special populations |
| Plan | Benefits plan | The same benefits plan |
| Cash benefits | Sick and maternity leave for contributors | Not applicable |
Markers
- SISBÉN
- Subsidised
- Portability
- Mobility
- Census list
In practice
- A person with no enrolment and no ability to pay must be treated, and their initial enrolment in the subsidised scheme follows (Law 1438, article 32).
- The Constitutional Court ordered the plans of both schemes to be unified, first for children and then for adults (ruling T-760 of 2008).
Reference norms
- Law 100 of 1993, articles 157 and 211 to 217.
- Law 1122 of 2007, article 14, and Law 1438 of 2011, articles 22, 32 and 33.
- Decree 780 of 2016: enrolment, mobility and portability.
- Constitutional Court, ruling T-760 of 2008: unification of the benefits plans.
Test yourself
Think of the answer, then tap the question to see it.
Who are the beneficiaries of the subsidised scheme?
Poor and vulnerable people unable to pay, identified through SISBÉN or lists of special populations.
How is the subsidised scheme funded?
With tax and solidarity resources that cover the contribution in full or in part; ADRES manages them.
What is portability?
The EPS's duty to guarantee access to services anywhere in the country, not only in the municipality of enrolment.
What is mobility between schemes?
Changing scheme (contributory or subsidised) within the same EPS when the enrollee's conditions change.
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 1438 de 2011 (Departamento Administrativo de la Función Pública, Colombia (Gestor Normativo), 2011); Decreto 780 de 2016 Sector Salud y Protección Social (Departamento Administrativo de la Función Pública, Colombia (Gestor Normativo), 2016); Sentencia T-760/08 (Corte Constitucional de Colombia, 2008).
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Representative model, for educational purposes only.