Clinics in Colombia operate with insufficient coverage: Why are they poorly insured?

Currently, the Colombian healthcare system is experiencing structural fragility due to limited insurance coverage for medical entities, leaving them exposed to financial, legal, and reputational risks that jeopardize their sustainability and public trust. According to the Special Registry of Healthcare Providers (REPS), there are 59,972 licensed institutions in the country, including clinics, hospitals, and care centers , a significant portion of which operate with inadequate policies or coverage that doesn't reflect their actual level of vulnerability.

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For years, medical liability insurance, a mechanism designed to protect healthcare institutions and professionals against claims for errors, omissions, or alleged malpractice, has been treated as a simple contractual or administrative requirement. However, in the midst of the current financial crisis in the sector, it is a key element for the legal and economic sustainability of providers , as a lawsuit for alleged negligence can represent a direct threat to an institution's viability, especially if the contracted protection does not have sufficient and continuous technical coverage.

Felix Ricardo Garzón Rojas, an insurance and reinsurance specialist, explains that this is because many clinics and hospitals choose their policies based solely on the cost of the premium, without evaluating the structure or scope of the contract. As a result, the coverage ends up being ineffective or inappropriate given the complexity of the medical risks they assume every day.

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“One of the main problems lies in the type of insurance most commonly used by medical institutions, known as Claims-Made. This model only covers claims filed while the policy is active. Therefore, if a hospital or clinic lets its insurance lapse, even if the incident occurred years ago, the insurer will not be held responsible,” he clarifies. This means that if an institution discontinues its coverage or changes insurance companies without proper advice, it may be completely unprotected against lawsuits for past medical care.

Added to this is the lack of specialized technical advice on insurance contracting and high turnover in administrative teams, which leads to poorly informed decisions and a loss of coverage continuity. "Many providers seemingly have policies in place, but without real protection against the legal, operational, and reputational risks of the current environment," explains Felix Ricardo Garzón.

This insurance gap has significant consequences for the system. Financially, a medical liability conviction can exceed an institution's financial capacity, compromising its operations or even forcing its closure. On the other hand, from a legal perspective, the lack of valid insurance forces institutions to directly assume the costs of defense and potential compensation, and on a reputational level, a lawsuit without insurance support can undermine the trust of patients and strategic allies .

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Given the current situation in the sector, specialist Felix Ricardo Garzón insists that the country needs a more technical and planned insurance culture, in which policies are designed based on each provider's actual exposure, with adequate insured amounts, continuity of coverage, and specialized support. Therefore, he recommends the use of new schemes, such as hybrid or dual policies, which combine the stability of occurrence-based coverage with the flexibility of the Claims Made model. These alternatives seek to guarantee continuous and effective protection, adjusted to the evolution of clinical and legal risk in the sector.

Properly insuring providers is an important condition for the stability of the Colombian healthcare system, where there is shared responsibility among insurers, reinsurers, health insurance companies, and the State. According to the most recent Así Vamos en Salud bulletin, 1.6 million Petitions, Complaints, Claims, and Suggestions (PQRS) were registered in 2024, along with a 34% increase in health-related lawsuits. These figures reflect user discontent and the urgent need to strengthen risk management and insurance protection in the sector.