Colombia EPS Debt Hits COP 58 Trillion, Only Four Insurers Comply

COLOMBIA · ECONOMY

Colombia’s comptroller says the country’s health insurers closed 2025 owing COP 58 trillion (US$18.3 billion) to hospitals, clinics and suppliers, with only four of the 28 companies meeting every financial requirement.

What the comptroller found

The numbers come from the Contraloría General de la República, Colombia’s national audit office. They were published on 31 August as part of its four-year review of health-sector finances.

The Colombia EPS debt, the money insurers owe to hospitals, clinics and medical suppliers, reached COP 58 trillion (US$18.3 billion) at the end of 2025. That is a 26.5 percent jump in a single year, or more than COP 12 trillion (US$3.8 billion) of new unpaid bills.

Behind the acronym sits a simple model. An EPS, short for Entidad Promotora de Salud, is a health insurer that collects a fixed payment per member and contracts doctors and hospitals for care.

Of the 28 insurers now operating, only four met every financial requirement set by law. Of the 26 that handed over data for the review, 17 posted losses in 2025.

Why the money ran out

The core problem is arithmetic, not scandal. The state pays each insurer a per-member fee called the UPC, the Unidad de Pago por Capitación or capitation payment unit.

The cost of actually treating patients has outgrown that fee. On average, insurers spent resources equal to 110 percent of the income available for care, the comptroller found.

A gap of ten pesos in every hundred does not sound dramatic. Multiplied across a system covering more than 50 million people, it is what produced the Colombia EPS debt now sitting on hospital balance sheets.

A separate count by the health-sector outlet ConsultorSalud put unpaid bills to service providers at COP 25.7 trillion (US$8.1 billion) in December 2025. That narrower measure, up COP 1.7 trillion (US$536 million) from June, tracks only part of the chain.

Nueva EPS, the biggest failure

One company dominates the Colombia EPS debt. Nueva EPS, taken over by the state in April 2024, covers about 11.6 million members, roughly one Colombian in five.

Its debt to the care network climbed from COP 22 trillion (US$6.9 billion) to almost COP 26 trillion (US$8.2 billion) in a single year. It also carries COP 17 trillion (US$5.4 billion) in advances that have never been justified in the accounts.

The paperwork tells its own story. Nueva EPS has not had financial statements approved since December 2023, and it has not closed the books for 2024 or 2025.

The state’s takeovers are not working

President Gustavo Petro’s government has seized control of several failing insurers, arguing that intervention protects patients. The comptroller’s data suggests the rescues are standing still.

In the first quarter of 2026, state-run insurers spent COP 117.8 for every COP 100 they received. Insurers still in private hands spent COP 100.8 per 100, barely better but moving in the same direction.

None of the intervened companies has rebuilt its net worth or come close to the minimum financial levels the law demands. That makes the Colombia EPS debt a problem the state now owns directly.

Four years of fiscal findings

The Colombia EPS debt figures sit inside a wider audit balance. Over the past four years the comptroller reports recovering COP 22.7 trillion (US$7.2 billion) of public money.

It logged 6,261 fiscal findings worth COP 28.2 trillion (US$8.9 billion). It opened 5,315 responsibility proceedings over COP 21.72 trillion (US$6.9 billion) and issued 1,090 rulings carrying fiscal liability of COP 3.37 trillion (US$1.1 billion).

Those totals cover all public spending, not only health. But health is where the unpaid bills are growing fastest.

What it means for expats and investors

For foreign residents, the practical effect shows up at the clinic door. Hospitals waiting on the Colombia EPS debt cut staff, delay non-urgent procedures and squeeze the appointments insurers must honour.

For investors, the Colombia EPS debt is a contingent public liability in waiting. If insurers cannot pay, the treasury eventually does, and Colombia’s 2027 budget is already under fire for its optimistic assumptions.

Congress buried Petro’s health reform, which would have replaced the insurers with a single state payer. The 2026 election season makes another attempt unlikely this year, so the arrears keep compounding.

Watch two dates. The comptroller’s next quarterly update on intervened insurers, and the finance ministry’s decision on raising the capitation fee for 2027, which would transfer the cost straight to the budget.

Frequently Asked Questions

This article was produced by The Rio Times’ automated newsroom system. How we use AI · Report an error