Solicitud directa (CEACR) - Adopción: 2005, Publicación: 95ª reunión CIT (2006)

Convenio sobre el seguro de enfermedad (industria), 1927 (núm. 24) - Colombia (Ratificación : 1933)

The Committee notes the reports provided by the Government in reply to its previous comments in relation to Conventions Nos. 24 and 25. However, it notes that they do not provide the detailed information requested in 2002 on the impact of all the legislation respecting the new General Social Security Health System (SGSSS) on the application of each of the Articles of the Convention and do not reply to its comments in relation to Articles 2; 3, paragraph 2; 4, paragraph 1; 6, paragraphs 1 and 2; and 9 of the Convention. The Committee is therefore bound to request the Government once again to provide all the information requested in its next report.

Article 2 of the Convention. The Committee requests the Government to provide statistical information on the number of persons insured under the contributory scheme of the SGSSS in relation to the total number of persons employed in industry, commerce and domestic service, in accordance with Part IV of the report form.

Article 3, paragraph 2. The Committee requests the Government to indicate whether, once this qualifying condition has been fulfilled, the provision of sickness benefit is subject to the completion of a waiting period. If so, please provide copies of the relevant provisions.

Article 4, paragraph 1. In its previous comments, the Committee drew the Government’s attention to the fact that this provision of the Convention does not provide for the possibility of making entitlement to medical care subject to the completion of a qualifying period. In this respect, it wishes to draw the Government’s attention to the following points:

(a)  The Committee notes that section 61 of Decree No. 806 of 1998 respecting the social security health scheme still establishes minimum periods of contribution for entitlement to the care necessary for the treatment of high-cost diseases: 100 weeks of contribution for diseases classified as catastrophic or ruinous under level IV of the compulsory health plan (POS) and 52 weeks for diseases needing surgery of an "optional nature", as set out in group 8 of the manual of activities, medical acts and procedures. Insured persons who wish to receive treatment before having completed this period of contribution have to pay a percentage of the total value of the treatment corresponding to the percentage of the missing weeks of contribution required to complete the minimum period of contribution. The Committee hopes that the Government will be able to re-examine this matter in the light of Article 4, paragraph 1, referred to above, and indicate the measures which have been taken or are envisaged to abolish, or at least at first to reduce these particularly long qualifying periods. It would be grateful if the Government would provide information on the implementation in practice of these qualifying periods, and particularly their impact on workers who do not have sufficient financial means to pay the proportion of medical costs corresponding to the missing weeks of contribution. The Committee also requests the Government to indicate whether the completion of these qualifying periods is required each time that the worker changes health-care provider (EPS).

(b)  Furthermore, the Committee notes that, under the terms of sections 74 to 76 of Decree No. 806 of 1998 above, workers are entitled to the benefits guaranteed by the POS four weeks after their registration with an EPS, except for emergency care, which is provided immediately. Workers who have been insured for 12 consecutive months with the same EPS nevertheless benefit from an additional period of protection of four weeks after the date of termination of their contract with the EPS. The Committee however notes that during this period of protection, care is only provided for diseases which are currently being treated or which are of an urgent nature. It also understands that the qualifying period of four weeks required to benefit from the whole range of care guaranteed by the POS is required each time that workers change EPS, irrespective of their number of years of coverage by the SGSSS. In these conditions, the Committee requests the Government to re-examine this matter and to indicate the measures which have been taken or are envisaged to give full effect to Article 4, paragraph 1, of the Convention.

Article 6, paragraph 1. The Committee notes the information provided by the Government regarding the monitoring and surveillance carried out by the National Health Superintendence with a view to ensuring the functioning of the SGSSS. It notes in particular Decree No. 1259 of 1994 defining the objectives of such supervision, and Circulars Nos. 21, 22 and 23 of 1996 issued by the Superintendence with a view to ensuring supervision at the regional and local levels. The Committee would be grateful if the Government would provide additional information in future reports on the operational difficulties encountered in practice by the contributory scheme of the SGSSS (coverage of all workers, guaranteeing the benefits envisaged by the POS to all insured persons, financial problems, etc.).

With reference more particularly to the EPS, the Committee notes Decree No. 1485 of 1994, regulating the organization and operation of these entities. In this respect, it once again requests the Government to confirm that, in accordance with Article 6, paragraph 1, of the Convention, EPS are not carried on with a view to profit. Please provide copies of any relevant legislative provisions.

Article 6, paragraph 2. In reply to the Committee’s previous comments, the Government states that Decree No. 1757 of 1994 determines procedures for social participation in the public health service. This is carried out in three manners: civic participation, community participation and participation in the institutions of the SGSSS. The Committee notes this information. It observes that, under the terms of sections 9-16 of Decree No. 1757 above, health-care institutions (public, private and mixed) have to convene their insured persons to establish users’ alliances or associations and to appoint their representatives. Section 14 of the Decree enumerates the functions of users’ associations, with subsection 3 providing that these associations shall participate in the executive board of EPS, both public and mixed, with a view to proposing and agreeing upon measures to maintain and improve the quality of the service. With regard to private EPS, participation is possible, in accordance with the respective legal provisions. In these conditions, the Committee would be grateful if the Government would provide information on the participation of insured persons in the management of private EPS, and particularly their executive boards. Please provide copies of the relevant provisions in this respect.

Article 9. The Committee notes the Government’s statement that, in the event of disputes, the right of appeal may be exercised through civil jurisdictions or labour jurisdictions or through administrative channels within the local health directorates or the National Health Superintendence. The Committee would be grateful if the Government would provide additional information on the channels of administrative appeal referred to above (procedures, relevant provisions of laws or regulations, etc.).