Demande directe (CEACR) - adoptée 2019, publiée 109ème session CIT (2021)

Colombie

Convention (n° 24) sur l'assurance-maladie (industrie), 1927 (Ratification: 1933)
Convention (n° 25) sur l'assurance-maladie (agriculture), 1927 (Ratification: 1933)

In order to provide a comprehensive view of the issues relating to the application of ratified Conventions on social security, the Committee considers it appropriate to examine Conventions Nos 24 (sickness insurance, industry) and 25 (sickness insurance, agriculture) together.

The Committee notes the observations of the General Confederation of Labour (CGT) on the application of Conventions Nos 24 and 25, received in 2017.

Article 4(1) of Conventions Nos 24 and 25. Access to medical care. The Committee notes the Government’s indication that 82.3 per cent of the almost 500,000 complaints received by the National Health Supervisory Office concern the restriction of access to health services. The Committee notes that, according to the CGT, these data show that the effective coverage of members or beneficiaries is completely deficient. The Committee requests the Government to provide its comments in this respect.

Article 4(2). Sharing in the cost of medical care. In its previous comments, the Committee asked the Government to provide statistical information on the number of workers who had been unable to pay the stipulated percentage for medical expenses, the number of workers who had paid a percentage of the total cost of the treatment, and the total amount paid in respect of these categories of beneficiaries. The Committee notes the information provided by the Government concerning the number of persons covered by the health system, which represented 95.66 per cent of the population in 2016, and the coverage of the General System of Occupational Risks, which was 39 per cent. The Committee once again requests the Government to provide detailed information concerning the participation of beneficiaries in the cost of medical care.

Article 6(1). Non-profit and profit-making health insurance institutions. In its previous comments, the Commission noted the Government's indications that there were 23 health promotion companies (EPS) operating under the contributory scheme, two of which were public, and requested the Government to provide statistical information on the activities of the management bodies, as well as of the national, district and municipal social security health councils that monitor the services to users. The Committee takes note of the Government’s indications that Decree No. 2462 of 2013 and its regulations delimit the functions for which the National Superintendence of Health (Supersalud) is responsible. In addition, the Government provides detailed data on, inter alia, the number of audits carried out by Supersalud in 2016 on EPS (430), the number of inspection visits to EPS customer service offices in the same year (245), the number of complaints received by Supersalud in 2016 (467,760) and the number of sanctions imposed (1,432). The Committee takes due note of the information provided by the Government on Supersalud and its activities, and reiterates its request to the Government to provide information on the activities of the national, district and municipal social security health councils that monitor services to users.

Article 6(2). Participation of insured persons in the management. In its previous comments, the Committee requested the Government to indicate the number of associations, leagues or alliances that operating within the EPS, as well as the conditions and requirements that the private EPS must adopt as part of their statutes and rules so that the users could participate in such bodies. The Committee takes note of the information provided by the Government concerning the number of associations and user alliances operating within 42 EPS. The Committee also requested the Government to clarify the functions of the National Social Security Council in the field of health (CNSSS) in relation to the Health Regulatory Commission (CRES), noting that at national level, the functions of the CNSSS had been considerably reduced, leaving most of its functions to CRES, which was not composed of social partners but by experts appointed by the President. With regard to the national level, the Committee notes the Government’s indication that CRES was liquidated by Decree No. 2560 of 2012 and that all its functions were transferred to the Directorate for the Regulation of Benefits, Costs and Tariffs of the Ministry of Health and Social Protection (Minsalud). The Committee also notes that section 3 of Act No. 1122 of 2007, to which the Government refers, establishes the consultative and advisory nature of the CNSSS, a tripartite body. On the basis of the information provided by the Government, the Committee observes that the Directorate of Minsalud, which replaced CRES in its functions, as well as the CNSSS, perform purely advisory functions and recalls in this respect, that Article 6(2) of the Conventions require the participation of insured persons in the management of the self-governing health insurance institutions. The Committee requests the Government to provide information on any measures taken or planned to ensure the full application of this Article of the Conventions at the national level. The Committee once again requests the Government to provide information on the conditions and requirements relating to the participation of insured persons in the management of private EPS.

Article 9 of Convention No. 24, and Article 8 of Convention No. 25. Right of appeal. The Committee notes the detailed information provided by the Government on the number of appeals submitted in relation to the right to health to the Constitutional Court in 2016. The Committee requests the Government to provide information on other legal remedies available at both the administrative and judicial levels in case of dispute concerning the right to benefit of insured persons established in the Conventions, as well as on the duration of the related proceedings. The Committee also requests the Government to provide information on the number of administrative and judicial appeals lodged and the time taken to process such appeals.

Application of Convention No. 24 in practice. Payment of health insurance . In its previous comment, the Committee requested the Government to indicate whether the employees of the International Aviation Company had recovered their rights with respect to health insurance, and to keep the Office informed in this regard. The Committee notes that the Government has not provided information on this subject and once again requests the Government to indicate the outcome of the investigation envisaged by the Ministry of Labour and the progress achieved in this regard.

Lastly, the Committee has been informed that, based on the recommendations of the Standards Review Mechanism Tripartite Working Group (SRM tripartite working group), the Governing Body has decided that member States for which Conventions Nos 24 and 25 are in force should be encouraged to ratify the Medical Care and Sickness Benefits Convention, 1969 (No. 130), or the Social Security (Minimum Standards) Convention, 1951 (No. 102), and accept its Parts II and III (see GB.328/LILS/2/1). The Committee therefore encourages the Government to follow up the Governing Body’s decision at its 328th Session (October–November 2016) approving the recommendations of the SRM tripartite working group and to consider ratifying Convention No. 130 or Convention No. 102 (and accept Parts II and III) as the most up-to-date instruments in this subject area.