My conference in Colombia: In this foreign country, health care challenges don’t seem so foreign

My Take

My conference in Colombia: In this foreign country, health care challenges don’t seem so foreign

By Sarah Thomas, managing director, Deloitte Center for Health Solutions, Deloitte Services LP

I was recently invited to present at the Health Forum (Foro de la Salud) in Cartagena, Colombia on the topic of innovation and value. I came back with some chocolate, a mild tan, and a new perspective on their health care challenges—many of which aren’t so different from our own.

The key issue I focused on at the meeting is the tension the health sector faces between opening the door to more innovative therapies while meeting the more basic public health needs of Colombia’s growing economy. The morning of my talk, the newspaper reported that Colombia has fewer people living in extreme poverty than ever before. With near-universal health care, a growing economy, and a new government that business leaders hope will be business-friendly, the country seems attractive for investment—from pharmaceutical manufacturers and other health investors. For now, the government appears to be keeping a pretty tight rein on both coverage and prices for innovative drugs, although I was told it supports intellectual property to a greater extent than in some neighboring countries.

Juan Pablo Uribe Restrepo, Colombia’s Minister of Health and Social Protection, laid out his perspective on the country’s health system during a thorough presentation. The new administration has been in place for only a few months, but Uribe seems to have done an in-depth analysis of the main issues. Based on his presentation, it appears that many of the overall indicators of outcomes (e.g., doctors per capita, life expectancy, child mortality) are moving in the right direction.

The key challenges in Colombia are familiar—meeting patient expectations, keeping spending sustainable, and raising the overall standard of care at hospitals. There is also a big focus on chronic conditions (the battle against communicable disease appears to be largely over).

Colombia is dealing with an influx of Venezuelan immigrants.1 While some of these immigrants could become important innovators or health industry professionals, others might pull resources from human services. In addition, the health minister pointed out that hospitals in many Colombian areas do not meet standards for quality and require investment to provide the level of care that people need.

Three innovations taking root in the US might also work in Colombia

The Deloitte Center for Health Solutions has done extensive research on a number of topics that might be of interest to stakeholders in both the US and Colombia. They include:

  • Telemedicine and virtual care: Although many Colombians live in the country’s major urban centers, telemedicine could provide a relatively low-cost way to get care to people in rural parts of the country and areas without enough providers. In the US, virtual health is expanding in hospitals and health systems, and patients, physicians, and employers are growing more comfortable with the idea, according to the results of our recent consumer survey.
  • Value-based payment for innovative drugs: As a condition of coverage, pharmaceutical manufacturers could contract with the Colombian government, or with the country’s many health plans (if they can cover these drugs), to take on more financial risk for the effectiveness and value of their products.
  • High-value care: Many of the case studies we describe in our report on low-value health care might be worth piloting in Colombia—potentially as public-private partnerships between the health plans and the government’s health authorities. I think that measuring consumer experience and quality and using financial incentives to draw attention to key clinical and access issues is a way for the country to deliver on its goals of meeting consumers’ expectations.

Colombia’s new leadership and relatively strong economy provide room, I think, to experiment with new payment models and support systems for physicians to help them target therapies to those who would benefit the most. I think this is equally true for the US. Even as we debate policies targeted at spending on drugs in the US, we should consider experimenting with ways to get the most value out of these game-changing therapies. We should keep in mind that some therapies are worth paying for if they keep people well, productive, and out of the hospital.

Not your typical US health conference

While there are many parallels between US and Colombian health systems, let me tell you about four fun differences I noticed between a typical US conference and the one I attended in Cartagena:

  1. Business casual: Especially among the women in the audience, I was struck by the vibrancy of the dress—bright and usually paired with dangly earrings—much more fun than the pencil skirts and suits in the US. Business casual for men meant no jackets, and I saw lots of linen shirts in the audience. I suspect this is due to the warm weather in Cartagena.
  2. Coffee: The coffee (“tinto”) in Colombia is delicious and served in very small cups with no milk. A waitress serves people in the audience, kind of like peanut vendors at a baseball game.
  3. International speakers: I was one of several speakers from another country, and it was fine to give my presentation in English. The conference offered devices for instant translation from English to Spanish for those who needed it. I rarely have seen non-English presentations at US conferences.
  4. Nametags: They were slightly larger than a compact-disc jewel case, and were by far the biggest nametags I’ve ever seen in my many years of going to conferences. It was large enough to fit the whole agenda for the three-day meeting on the back! I found this very handy for reference and for spotting fellow conference-goers from far away.

An important debate in Colombia is whether the country has reached a tipping point in its economic development where it can open the door for transformative therapies and innovation in health care more broadly. Opening that door could be a step in the right direction. Along with creating more jobs, it also could lead to new innovations. Although health is defined as a fundamental right in Colombia, many people don’t have access to the health care system. However, unlike the US, Colombia might be able to try new initiatives without needing to prioritize the expansion of coverage and financing mechanisms.

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