What are the most common complaints against EPSs in Colombia?

According to figures published by the National Health Superintendency , the health complaint rate reached a record 322 complaints per 10,000 members between December 2023 and November 2024 , a considerable increase compared to the 274.65 cases per 10,000 registered in the previous period . What were the main problems with the EPS?

This average reflects a growing problem that concerns both authorities and system users. Therefore, it is extremely important for citizens to understand the real role played by Health Promotion Entities (EPS), as intermediaries between the State, health providers (such as clinics and hospitals), and users. Whether public or private, these entities manage the health system's resources to ensure adequate coverage, and therefore play a crucial role in citizens' access to healthcare, from a general consultation to complex surgery.

(READ MORE : These are the EPSs that could disappear in Colombia by 2025 )

Main reasons for the claim

According to a report published by the specialized portal consultorsalud , the most recurrent problems that cause the most distress among patients who require timely attention are the following:

1) Denial or delay in appointments with specialists

2) Medical treatments or technologies (such as tests or devices) included in the plan, which are not authorized

3) Delays in the delivery of essential medicines as stipulated in health benefits.

An alarming fact is that more than 61% of complaints were received directly by the Health Superintendency, while only 38.81% were processed by the health authorities. The most extreme case is that of Coosalud, where only 11.65% of complaints were handled by the entity, delegating the rest to the national government agency, a situation that demonstrates a lack of appropriate response by many health authorities.

(READ MORE : Do you need to apply for a Bogotá subsidy? This is the only requirement they ask for )

Furthermore, in October 2024, regions such as Risaralda and Caldas stood out for having the highest rates (55.88 and 48.69 per 10,000 members, respectively), and EPSs such as Comfenalco Valle and Servicios Occidentales de Salud also exceeded the national average.

Although slight declines in the number of claims were observed in the last months of 2024 and the first months of 2025, the figures remain at historically high levels.

​

Intervention and performance of the EPS

In the current context of the financial crisis reported by several EPSs and failures in service provision, the Health Superintendency continues to intervene in many of them with the goal of ensuring more efficient and timely care. In this context, Health Superintendent Giovanny Rubiano announced several measures implemented in coordination with the EPSs to contain complaints and improve care, such as expanding the number of appointments and specialists and strengthening referrals to the public network and medication distribution channels.

At the same time, the Health Superintendency is moving forward with audits of the intervened EPSs to evaluate both their finances and the quality of service delivery.

​