What Out-of-Pocket Health Spending Is Costing Colombia (and Why AI Can Actually Lower It)
I’ll open with a number that, after years of watching how household budgets actually behave, still strikes me as brutal: out-of-pocket health spending in Colombia rose to 16.8% of current health expenditure in 2024, up from 14.2% in 2021 — and we’re now closing in on the 20% threshold the World Health Organization classifies as catastrophic financial risk for a household. In raw terms: Colombian households spent $128 trillion COP on health in 2025, and health now accounts for 6.9% of GDP, up from 6.3% in 2022. This isn’t an abstract statistic. It’s the difference between a household that can absorb a serious illness and one that gets financially wiped out by it.
Where Colombia stands against the OECD
Measured against OECD standards, Colombia isn’t in the worst spot, but it’s nowhere near the best either: we sit above Chile (10%) and at a level similar to Brazil (25%), according to the most recent OECD report on health in Colombia. In other words, we still lean more on the patient’s pocket than most developed countries, which finance healthcare far more collectively through taxes or robust mandatory insurance schemes. OECD methodology treats any out-of-pocket spending above 20% of a household’s total health expenditure as catastrophic — Colombia has spent four years moving toward that line, not away from it.
What the new government is proposing — and what it still doesn’t say
Abelardo de la Espriella’s government announced a rescue plan of up to $10 trillion COP in its first 90 days: $4 trillion to pay back wages and overdue debts to hospitals and clinics, $2 trillion to reduce the backlog of high-cost-illness patients, caps on EPS administrative spending, and liquidation of insurers that fail to meet technical standards. It’s a supply-side stabilization plan — paying whoever already provided the service — not yet an explicit strategy to bring down structural out-of-pocket spending. That’s the piece that, in my read, is still missing: you can clean up today’s hospital debt without the average patient’s pocket improving one bit next year.
AI’s real role, without overselling it
This is where I think artificial intelligence genuinely has a concrete role, not a fashionable one: assisted diagnosis and telemedicine reduce the need for a patient to pay out of pocket for in-person visits and travel — especially in rural areas where medical supply is scarce — and early detection lowers the total cost of treating an advanced illness versus one caught early. It’s not a magic fix and it doesn’t replace structural reform of the health system, but it’s the only lever in this government’s plan that can move the out-of-pocket indicator without depending on the state having more money to inject every 90 days.
My question for anyone following this reform: will the standard for whether it worked be that overdue debts got paid, or that out-of-pocket spending is below 16.8% a year from now? Those are different things, and only the second one actually protects the patient’s pocket.
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