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Reclamos, tutelas y cobertura en riesgo: así está el acceso a la salud en Colombia en 2025
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El acceso a la salud en Colombia atraviesa una etapa crítica. Aunque las cifras de afiliación se mantienen cerca del 100%, los indicadores de acceso efectivo, cobertura, oportunidad en la atención, satisfacción de los usuarios y sostenibilidad del sistema revelan síntomas de alarma. Así lo evidencia el Boletín N.º 5 del Centro de Pensamiento Así Vamos en Salud, que ofrece un análisis detallado sustentado en datos oficiales con trazabilidad histórica.
La publicación, subraya que garantizar el derecho a la salud no se limita a la afiliación formal, sino que exige condiciones reales para acceder a servicios oportunos, continuos y de calidad. La información recopilada deja en evidencia un sistema tensionado por el descenso en la cobertura, la reducción en la capacidad instalada y el incremento sostenido de reclamos y acciones judiciales.
Cobertura en descenso: ¿afiliación cercana al 100% o principio de universalidad en riesgo?
Aunque la afiliación al sistema de salud se reporta en 98,45% a junio de 2025, el dato representa una caída sostenida desde 2022. Esta reducción, combinada con el aumento del número de personas en el régimen subsidiado, pone en entredicho la universalidad del aseguramiento. La Corte Constitucional ha señalado con preocupación el descenso del 3,5% durante 2023 y ha exigido al Gobierno medidas correctivas, así como verificación de los datos para 2024.
El boletín advierte sobre inconsistencias entre los datos reportados por el Ministerio de Salud y los presentados ante la Corte, lo que compromete la transparencia y dificulta el monitoreo efectivo de la garantía del derecho a la salud.
Capacidad instalada: caídas en UCI neonatal y atención materna
Entre enero de 2024 y julio de 2025, el sistema registró retrocesos en varios componentes clave de la infraestructura hospitalaria:
- Las camas de UCI neonatal disminuyeron un 7,5%.
- Las camas para trabajo de parto, parto y postparto cayeron en 7,1%.
- Las camas de salud mental para adultos se redujeron en 6%, mientras que en pediatría aumentaron 28%.
Estos descensos, especialmente en servicios maternoinfantiles y salud mental adulta, comprometen el logro de metas nacionales e internacionales en reducción de mortalidad materna e infantil, y afectan de forma particular a zonas apartadas donde la oferta es limitada.
PQRS y tutelas: la insatisfacción con el sistema se vuelve visible
El boletín destaca un crecimiento sostenido en los mecanismos formales de expresión del descontento ciudadano. Entre enero y junio de 2025 se registraron 978.177 quejas (PQRS), un aumento del 36% frente al mismo periodo de 2024. De estas, el 93% está relacionada con barreras de acceso a servicios y tecnologías en salud. Si la tendencia se mantiene, se proyecta un incremento del 56% al cierre del año.
Particularmente preocupante es que en las EPS intervenidas, las quejas aumentaron después de la intervención: Famisanar (+41%), Nueva EPS (+44%) y Sanitas (+27%).
El uso de la tutela como vía para reclamar el derecho a la salud también va en aumento. Hasta mayo de 2025 se radicaron 125.819 tutelas, lo que representa un crecimiento del 16,4% en comparación con el mismo periodo del año anterior. Las principales pretensiones están relacionadas con:
- Procedimientos oportunos (33%)
- Entrega de medicamentos (24,4%)
- Tratamiento integral (22,2%)
Estos datos superan el récord histórico de 2019, y confirman que el acceso efectivo al derecho a la salud continúa dependiendo de mecanismos judiciales.
Planes voluntarios: búsqueda de refugio frente a la incertidumbre
Frente a la incertidumbre institucional y operativa, muchos ciudadanos han optado por recurrir a alternativas privadas. El mercado de Planes Voluntarios de Salud (PVS) creció un 6,7% entre 2023 y 2024, alcanzando 4,4 millones de personas afiliadas.
El producto que más creció fue el de pólizas, con un aumento del 37%, superando a la medicina prepagada como la opción preferida. Esta tendencia refleja una pérdida de confianza en la capacidad resolutiva del sistema público y plantea interrogantes sobre la equidad del modelo.
Consulte el Boletín N.º 5 del Centro de Pensamiento Así Vamos en Salud aquí:
Tatiana Asprilla
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