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Previous comments: Direct requests C.12, C.17, C.18 and C.19; direct requests C.24 and C.25

The Committee notes the observations provided by the Single Confederation of Workers of Colombia (CUT), the General Confederation of Labour (CGT) and the Confederation of Workers of Colombia (CTC) on the application of Conventions Nos 12, 17, 18 and 19, dated 31 August 2022, which were communicated with the Government’s report. The Committee requests the Government to provide its comments in this regard.
The Committee also notes the observations of the International Organisation of Employers (IOE) and the National Employers Association of Colombia (ANDI), dated 31 August 2022, communicated with the Government’s report.
In order to provide a comprehensive view of the issues relating to the application of ratified social security Conventions, the Committee considers it appropriate to examine Conventions Nos 12, 17, 18, 19, 24 and 25 together in a single comment.
Article 1, Conventions Nos 12, 17, 18, 24 and 25. Representation made under article 24 of the ILO Constitution. Application of the Conventions in practice. Progressive extension of the numbers of persons covered. The Committee notes that, at its 342nd Session (June 2021), the Governing Body found receivable the representation made by the CUT, CGT and CTC under article 24 of the ILO Constitution alleging non-compliance by the Government of Colombia with the Maternity Protection Convention, 1919 (No. 3), the Workmen’s Compensation (Agriculture) Convention, 1921 (No. 12), the Workmen’s Compensation (Accidents) Convention, 1925 (No. 17), the Workmen’s Compensation (Occupational Diseases) Convention, 1925 (No. 18), the Sickness Insurance (Industry) Convention, 1927 (No. 24), the Sickness Insurance (Agriculture) Convention, 1927 (No. 25), and the Tripartite Consultation (International Labour Standards) Convention, 1976 (No. 144). The Committee observes that the allegations contained in the representation refer to the coverage of protected persons and the guarantee of social security benefits in relation to Conventions Nos 3, 12, 17, 18, 24 and 25. In accordance with its usual practice, the Committee has decided to suspend its examination of matters related to the subjects referred to until the Governing Body adopts its report on the representation.
Article 5 of Convention No. 17. Compensation in the form of a lump sum. The Committee notes the information provided by the Government on guarantees of stability of employment and the obligation of employers to provide rehabilitation measures. The Committee also notes that the legislation provides for the payment of a higher-level compensation benefit in the event of permanent partial incapacity. In this regard, the Committee observes that the Government has not indicated the measures adopted with a view to guaranteeing the proper utilization of the lump sum received in such circumstances. The Committee wishes to recall that Article 5 of the Convention provides that the compensation payable in the event of permanent incapacity or death may as an exception be wholly or partially paid in a lump sum, if the competent authority is satisfied that it will be properly utilized. In this context, the Committee once again requests the Government to indicate the measures adopted so that the competent authorities ensure the proper utilization of the lump sum benefit, in accordance with Article 5 of the Convention.
Article 11 of Convention No. 17.Guarantees of the payment of benefits to workers in the event of the insolvency of the employer or the insurer, and in cases of the failure to register workers. The Committee notes the information provided by the Government in its report that occupational risk administrators are required to take out reinsurance coverage, and that the Guarantee Fund for Financial Institutions (FOGAFIN) is responsible for the payment of pensions in the event of the insolvency of the pension administrator. The Committee further notes that, in the event of the insolvency of enterprises, Act No. 1116 of 2006 grants preference to labour credits, as a result of which workers in enterprises under compulsory liquidation are assisted by the law, on an equal footing, to benefit from the distribution of the active assets during liquidation. With reference to the failure to register workers, the Committee notes that, in the case of workers who are not registered under the General Labour Risks Scheme (SGRL), the State does not guarantee the payment of employment injury benefits, and workers have to have recourse to the ordinary labour courts to make their claims against the responsible employer. In this regard, the Committee notes the observations of the CUT, CGT and CTC indicating that court action takes years to be completed and is costly. The Committee recalls the Government that Article 11 of Convention No. 17 provides that Member States shall make such provision as is deemed most suitable for ensuring in all circumstances the payment of compensation to workers who suffer injury and to their dependants. In this context, the Committee requests the Government to indicate the manner in which the payment of compensation is guaranteed in the case of workers who are not registered with the SGRL, over and above the possibility for them to take action through the ordinary courts. The Committee also requests the Government to provide information on the court rulings handed down recognizing the payment of such compensation.
Article 2 of Convention No. 18. Recognition of occupational diseases. The Committee notes the indication that the regulations on recognition on first application through administrative decisions have been under revision since 4 March 2022 by the Ministry of Finance and Public Credit, which is seeking to reduce to 140 days the procedure for the determination and recognition of loss of capacity for work in all cases. The Committee further notes the Government’s indication that work is being undertaken on a draft text to add Part 5 of Book 3 to Decree No. 780 of 2016, regulating the health and social protection sector, which establishes the procedure for determining the origin of the disease or injury, the degree of invalidity and the date of the recognition and review of the invalidity. In light of the above, the Committee requests the Government to provide information on: (i) progress in the adoption of the regulations referred to above, with a view to the simplification of the process of the recognition of occupational diseases upon first application, and the reduction in the timeframe for their recognition; and (ii) the number of occupational diseases that have been reported and recognized, and the average period of time between their recording and their recognition.
Application in practice of Convention No. 19. The Committee notes the information provided by the Government on the adoption of Decree No. 117 of 2020 establishing a procedure to regularize the status of migrants with a view to reducing informal work and allowing the access to work with insurance coverage of Venezuelan citizens in an irregular migration situation. The Committee also notes Decision No. 1178 of 2021 and Decision No. 572 of 2022 of the Ministry of Health and Social Protection, adopting the temporary protection permit (PPT) as a valid identity document for Venezuelan migrants, with which they can register with the General Social Security System and the General Occupational Risks Scheme, through which they benefit from relevant protection and benefits for employment injuries. The Committee notes the observations of the CUT, CGT and CTC which indicate a lack of the necessary labour inspection to ensure compliance by employers with their obligations under labour law, as workers of Venezuelan nationality are subject to unfair treatment as a result of their vulnerable situation. In this regard, the Committee requests the Government to indicate whether the labour inspection services have reported irregularities in the payment of employment injury compensation to migrant workers.
Article 4(1) of Conventions Nos 24 and 25. Access to medical care. The Committee notes the information provided by the Government on the supervisory measures adopted by the National Health Supervisory Office in relation to health promotion bodies (EPS) and health service providers (IPS) to ensure that they comply with their obligations. The Committee also notes the statistical data, which shows that the number of complaints relating to access to medical care has diminished.
Article 4(2) of Conventions Nos 24 and 25. Sharing in the cost of medical care. The Committee notes the information provided by the Government that the cost share by beneficiaries in Colombia is 15.1 per cent, and that the share of the cost of health services paid by households represents 1.7 per cent of the total cost. The Committee recalls that, while Article 4(2) of the Convention provides that the insured person may be required to pay such part of the cost of medical care as may be prescribed by national laws or regulations, the principle of the provision of care free-of-charge is also established. In this context, the Committee requests the Government to provide information on the public financial assistance measures or policies that exist with a view to preventing hardship for insured persons, especially in cases which may require multiple consultations and complex or long-term medical treatment.
Article 6(1) of Conventions Nos 24 and 25. Non-profit and profit-making health insurance institutions. The Committee notes the information provided on the National Health Supervisory Office in relation to the adoption of measures with a view to the removal of the approval of institutions that do not guarantee the provision of health services to their members, including the partial revocation of the authorization to operate and precautionary measures. However, the Committee notes that the Government has not provided information on the controls carried out of user services by national, district and municipal social security councils in the field of health care. In this context, the Committee once again requests the Government to provide information on the supervisory activities of national, district and municipal social security health councils to monitor user services.
Article 6(2) of Conventions Nos 24 and 25. Participation of insured persons in management. The Committee notes the information provided by the Government on user alliances and associations, the role of which is to represent users in relation to health promotion bodies (EPS) and health service providers (IPS). The Committee further notes External Circular No. 008 of 2018 of the National Health Supervisory Office, which indicates that Benefit Plan Administrators (EAPB) and health service providers (IPS) shall take the necessary action to promote and strengthen the exercise of social participation in accordance with the laws and regulations in force.
Article 9 of Convention No. 24 and Article 8 of Convention No. 25. Right of appeal. The Committee notes the Government’s indication that, within the context of the Social Security System, there exist bodies, time limits and procedures regulated by Decree No. 1072 of 26 May 2015 and Legislative Decree No. 19 of 2012 on the right of appeal in relation to the recognition and granting of benefits for injury and diseases. The Committee notes the procedures described in relation to the recognition authority, the Regional Injury Recognition Board and the National Injury Recognition Board. It also notes the indication that, in addition to the administrative bodies referred to above, persons who are affected may take action through judicial bodies.
Application of Convention No. 24 in practice. Payment of health insurance. The Committee notes the information on the proceedings undertaken by the Supervisory Body delegated by the jurisdictional and conciliation authorities for the resolution of disputes that arose between users and providers in the health care system during the period between August 2018 and July 2022, which does not refer specifically to any progress in the action taken in relation to the employees of the International Aviation Company. The Committee recalls that the Government indicated in previous reports that the Ministry of Labour was undertaking an investigation and that a round table had been established under the leadership of the Deputy Minister for Industrial Relations and Inspection with a view to reaching an agreement. The Committee once again requests the Government to provide specific information on any progress achieved and the possibility of concluding this case.
Conclusions and recommendation of the Standards Review Mechanism. The Committee recalls the recommendations of the Tripartite Working Group of the Standards Review Mechanism, on the basis of which the Governing Body decided that Member States for which Conventions Nos 17, 18, 24 and 25 are in force should be encouraged to ratify the Employment Injury Benefits Convention [Schedule I amended in 1980], 1964 (No. 121), the Medical Care and Sickness Benefits Convention, 1969 (No. 130), and the Social Security (Minimum Standards) Convention, 1952 (No. 102). The Committee encourages the Government to give effect to the decision adopted by the Government Body at its 328th Session (October–November 2016) and to consider the ratification of the most up-to-date social security instruments.

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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.

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Article 4(1) of the Convention. Minimum periods of contribution required for entitlement to medical care. The Committee takes note that, pursuant to article 61(2) of Decree No. 806 of 1998, a contributing member who is not in a financial position to pay the established percentage and who has proved his or her situation to the institution must, along with his or her beneficiaries, be given treatment by the public health service institutions, or by private institutions with which the State has a contractual arrangement. The said institutions may charge a corresponding fee.
The Single Confederation of Workers of Colombia (CUT) states that, under the current compulsory health plan (POS), during the first four weeks of contribution insured persons are entitled to emergency treatment, maternity care, treatment for a newborn child and promotional and preventive services; between four and 26 weeks they are entitled to general and specialized medical consultations (the patient must be referred to a specialist by the general practitioner), to laboratory tests and diagnostic assistance, to such medication as is covered by the health plan and to hospitalization and low-complexity surgery; after 26 weeks they are entitled to hospitalization and medium-complexity surgery and to treatment for serious or high-cost illness.
Article 4(2). Participation in the cost of medical care. The Committee also takes note that, pursuant to article 61(1) of the aforementioned Decree, insured persons bound by minimum periods of contribution who wish to receive treatment before the stipulated minimum period (26 weeks) must pay a percentage of the total value of the treatment corresponding to the percentage in weekly contributions that remain before they have completed the minimum period.
The Committee takes note of this information and of the fact that all workers are entitled to medical treatment from the first day they are insured, including workers who do not have sufficient financial means to pay the medical costs. The Committee requests the Government to send it statistical data on the number of workers who have been unable to pay the stipulated percentage, the number of workers who have paid a percentage of the total cost of the treatment, and the total amount paid in respect of these categories of beneficiaries.
Article 6(1). Non-profit-making and profit-making sickness insurance institutions. Regarding the proportion of workers covered by public health-care providers (EPS) compared to members of private providers, the Government states that the system has 23 health-care providers, two of which are public and provide medical services and treatment to 0.38 per cent of the total number of contributors covered. The CUT states that, since the adoption of Act No. 100 of 1993, the private sector has been gaining a lot of ground and today not a single health-care provider belongs entirely to the State. It adds that Act No. 1151 of 2007 authorized the entry of private capital into the one remaining public provider, thus creating a new health-care provider which, although the State maintains a share in it, is mostly funded by private capital. In practice, the proportion of workers covered by public providers is virtually nil. However, bearing in mind that almost half of the new health-care provider is funded by state capital, the proportion in terms of membership was 13.7 per cent in 2011.
Regarding the protection of workers against contingencies covered by profit making health insurance companies, the Government states that machinery exists at the community level for monitoring the system; these are management, monitoring and control bodies and administration and financing bodies (Ministry of Labour, Ministry of Health and Social Welfare, the Regulatory Health Committee, national health and finance departments, health promotion bodies, section, district and local health departments and the Solidarity and Guarantee Fund). In addition, the system recommends that the various agents be consulted at every level through national, district and municipal social security health councils and establishes mechanisms for monitoring the health services so as to guarantee that their users receive quality treatment that is appropriate, personalized, human, comprehensive and permanent, in accordance with the accepted standards of professional procedures and practices. On this point, the CUT notes that there is a conflict between the provision of adequate services and the profit-making nature of the health-care providers, which are known to have as far as possible prevented the affiliation of population groups that have traditionally been discriminated against and groups that are manifestly vulnerable. In addition to legislative restrictions, insured persons have to contend with the administrative obstacles posed by the system’s various bodies which hamper their effective enjoyment of the right to health. The Committee recalls that, under the terms of the Convention, sickness insurance must be administered by self-governing institutions that may not be operated with a view to profit, so as to prevent their skimping on the services they provide for reasons other than the beneficiaries’ health. The Committee requests the Government to provide information on the activities of the management bodies and of the national, district and municipal social security health councils that monitor the services to users; for example, in the form of reports on inspections, on the penalties for infringing the regulations and on the number of complaints concerning the quality of the services.
Article 6(2). Participation of insured persons in management. The Government states that, pursuant to Decree No. 1018 of 2007, the National Health Department encourages public involvement and oversight and the establishment of associations, leagues or alliances of users of the health-care providers’ services. The presence of representatives of the user community on the executive boards of public institutions is compulsory. Moreover, regarding the participation of insured persons in the executive boards of private health-care providers, article 14(3) of Decree No. 1757 of 1994 stipulates that such participation must be in accordance with the legal provisions on the matter. The National Health Department has, with the Ministry of Health and Social Welfare, been engaging in consultations on the drafting of regulations laying down the conditions and requirements that private health-care providers must adopt as part of their statutes and rules so that users may participate in the management of the private health-care providers. The CUT notes that the State has not developed any machinery for guaranteeing direct participation by the most representative organizations. The Committee requests the Government to indicate the number of associations, leagues or alliances that are currently operating within the health-care providers, as well as the conditions and requirements that the latter must adopt as part of their statutes and rules so that the users can participate in such bodies. The Committee also requests the Government to keep it informed of the outcome of the consultations carried out and of any rules and regulations on the subject.
The National Social Security Health Council (CNSSS) and the Health Regulation Committee (CRES). Regarding the function of the social partners within the CRES and their replacement by experts elected by users’ associations, the Government states that section 3 of Act No. 1122 of 2007 left it to the Ministry of Health and Social Welfare to regulate the function of the CNSSS advisory services. Since no such regulations were issued, the CNSSS was unable to function and the CRES was therefore not able to consult it. Section 3 was subsequently repealed and those functions of the Council that were not assigned to the CRES currently have no legal definition as they are not referred to in the legislation. The Committee notes that the functions of the CNSSS are now greatly reduced as most of them have been transferred to the CRES, which is no longer composed of the social partners but of experts appointed by the President. The Committee recalls that the Convention requires that the insured persons participate in the administration of self-governing insurance institutions. The Committee therefore once again requests the Government to indicate which users’ associations were chosen to propose the experts that make up the CRES and to clarify the current functions of the CNSSS vis-à-vis the CRES now that its advisory functions have been suspended. The Committee also requests the Government to take the necessary steps for regulations to be adopted that will restore the functions of the CNSSS and to keep the Office informed of developments.
Article 9. Appeal. In its earlier comments, the Committee requested the Government to inform it of the administrative channels of appeal available to insured persons in the event of objections to their right to benefits. On this point, the CUT states that legal appeals of a judicial and administrative nature have proved inefficient, mainly because of the authorities’ slowness in settling disputes with respect to the benefits provided under the general system. Consequently, these have been resolved through official requests for court protection or amparo, which have now have become the rule. Taking note of this information and of the fact that the Government has not provided the information it requested, the Committee again requests the Government to send all relevant information, together with information on the duration of proceedings with respect to the provision of services and on the number of requests for court protection or amparo that have been lodged in this connection.
Payment of health insurance – Intercontinental Aviation Company. In its previous request, the Committee requested the Government to indicate whether the employees of the Intercontinental Aviation Company had recovered their rights with respect to health insurance. The Government informs the Committee that the Ministry of Labour is conducting an inquiry and that a working group headed by the Vice-Minister of Labour Relations and Inspection has been set up to reach an agreement on the matter. The first meeting was held in June 2012 and another was scheduled for August 2012. The Committee takes note of this information and requests the Government to keep the Office informed of the outcome of the inquiry and of any agreement reached in this respect.

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Regarding the points raised in its earlier comments, the Committee takes note with satisfaction of the adoption of Act No. 1438 of 19 January 2011 reforming the General Social Security Health System (SGSSS), and specifically that:
  • -section 32 establishes the principle of universality of sickness insurance, in accordance with Article 2 of the Convention;
  • -there is no qualifying period under the SGSSS for access to health services or to the treatment of high-cost illnesses, and the imposition of any restriction on access to such services by a health-care provider is prohibited, in accordance with Article 3(2) of the Convention; and
  • -the qualifying periods for access to sickness benefits have been modified by Act No. 1122 of 2007 – for example, 26 weeks of contributions – and contributions already paid are not forfeited on account of the non-payment of contributions to the system for six or more successive months, in accordance with Article 4(1) of the Convention.
The Committee is raising other points in a request addressed directly to the Government.

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With reference to its previous comments, the Committee notes that Act No. 1122 of 2007 has been adopted in order to reform the General Social Security Health System (SGSSS), provide the resources needed ultimately to cover the whole population and improve the quality and efficiency of the health services. The Committee wishes to draw the Government’s attention to the following points.

Article 2 of the Convention. Persons covered by sickness insurance. The statistical information sent by the Government shows an increase in the number of persons affiliated to the SGSSS contributory scheme, from 5.3 million in 2000 to nearly 8 million in 2008. The Committee notes this development with interest and requests the Government to continue to keep it informed on the process for expanding health coverage, indicating whether, in practice, there are still persons protected by the Convention who do not as yet have sickness insurance coverage.

Article 3, paragraph 2. Waiting period. The Committee requests the Government to state whether, as the Committee understands it, payment of sickness benefit is subject to completion of a waiting period of four days, and reminds the Government that according to the Convention, a waiting period must be no longer than three days at most.

Article, 4, paragraph 1. Minimum periods of contribution required for entitlement to medical care. In its previous comments, the Committee draws the Government’s attention to the fact that this provision of the Convention does not allow for the possibility of making entitlement to medical care subject to the completion of a qualifying period. The Government indicates that Act No. 1122 mentioned above has had the effect of capping at 26 weeks the minimum periods of contribution required for entitlement to the benefits. It further indicates, in respect of medical benefits, that SGSSS coverage is effective from the date of affiliation to the social security system as a whole; only emergency services are provided during the first month of affiliation. The Committee takes note of this information and requests the Government to indicate whether Act No. 1122 has in effect rendered inoperative section 61 of Decree No. 806 of 1998 on the social security health scheme which provides for very long minimum periods of contribution for entitlement to the care needed for the treatment of high-cost diseases: 100 weeks of contribution for diseases classified as disastrous or ruinous under level IV of the compulsory health plan (POS), and 52 weeks for illnesses requiring selective surgery, as set out in group 8 of the manual of activities, medical acts and procedures (insured persons wishing to receive treatment before completing this period of contributions 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 also invites the Government to consider the possibility of eliminating in future all qualifying periods for medical care so as to bring the national legislation fully into line with Article 4, paragraph 1, of the Convention. Please indicate whether there are any mechanisms whereby it can be ensured that workers who lack the financial means to cover their medical costs are nonetheless able to receive the necessary medical services.

The Committee notes from the information sent by the Government that the qualifying period of four weeks required for entitlement to the medical benefits covered by the compulsory health plan (POS) does not have to be completed when a worker changes health-care provider (EPS).

Article 6, paragraph 1. Non-profit-making and profit-making sickness insurance institutions. The Government indicates in its report that the SGSSS is a public service but is so designed that it can be administered and operated both by private interests and by the State. The State is responsible for organization and oversight and for ensuring that it runs efficiently so that the entire population has access to health services. In its report, the Government refers in this context to an Order of 2001 issued by the Constitutional Court allowing Parliament the freedom to choose among various social security organization systems; the Constitution opts neither for a strictly private system nor for a purely public one. The Government adds that the SGSSS may, therefore, be organized and run for profit. The Committee takes note of this information and recalls that, according to the Convention, sickness insurance must be administered by self-governing institutions under the administrative and financial supervision of the public authorities and must not be carried out with a view to profit. Institutions founded by private initiative must be specially approved by the public authorities. The Government is asked to indicate the proportion of workers covered by public EPSs as compared to those affiliated to private ones, and to specify the procedures set up to oversee the proper running of private EPSs by the public authorities and to protect workers from risks related to sickness insurance carried out for profit (overcharging, negative selection, etc.). Please provide information on any difficulties encountered in practice by the SGSSS contributory scheme (coverage of all workers, guaranteeing the benefits provided by the POS to all insured persons, financial problems, etc.).

Article 6, paragraph 2. Participation of insured persons in management. In its previous comments, the Committee noted that Decree No. 1757 of 1994 determines procedures for social participation in the public health service, of which there are three: civic participation, community participation and participation in the institutions of the SGSSS. Furthermore, pursuant to sections 9 to 16 of the Decree, health-care institutions (public, private or mixed) are required to call on their members to establish users’ alliances or associations and appoint their representatives. These associations participate in the steering committees of public and mixed EPSs in order to propose and agree on measures to maintain and improve service quality. As for private EPSs, participation is possible, in accordance with the relevant legal provisions. The Committee notes that the Government’s report does not provide the information requested previously on the participation of insured persons in the management of private EPSs, including their steering committees, and trusts that the Government will not fail to provide this information in its next report.

The Committee further notes that Act No. 1122, adopted in 2007, established the Health Regulation Committee (CRES), which is now the main regulatory body for health, replacing the National Social Security Council (CNSSS), which nonetheless has consultative status with the CRES. Unlike the CNSSS, which is composed, inter alia, of employers’ and workers’ representatives, the new regulatory body consists mainly of experts appointed by the President of the Republic from a shortlist proposed, inter alia, by properly organized users’ associations. The Committee invites the Government to keep it informed of the implementation of the new system and to indicate in particular the users’ associations that were called on to nominate the experts appointed to the CRES. Furthermore, the Committee observes that the social partners have a lesser role in the new regulatory body, being replaced by independent experts. It asks the Government to specify the reach of CNSSS consultation in decision-making by the CRES.

Article 9. Appeal. The Government indicated previously that, in the event of a dispute, appeal lies to the civil courts, the labour courts or, through administrative channels, to the local health directorates or the National Health Supervisory Authority. The Committee, in response, asked the Government to provide additional information on the administrative channels of appeal (procedures, relevant provisions of laws or regulations and their implementation, etc.). In its latest report, the Government merely refers the Committee to Decree No. 1018 of 30 March 2007 to restructure the abovementioned Supervisory Authority, which contains no provisions on the organization of the administrative means of redress open to insured persons wishing to file claims concerning their entitlements. The Committee hopes that the Government will ensure that all relevant information is sent in its next report.

Lastly, with reference to its observation, the Committee notes from the information sent by the Government that the matter of the non-payment of social security contributions by Intercontinental de Aviación between 1998 and 2004 is still under examination by the labour inspection services responsible for implementing the decision ordering payment of the sums due in respect of the social security contributions. The representatives of the parties are shortly to be called to another hearing by the inspection services since the workers’ representatives did not respond to the summonses to proceedings addressed to them in July and August 2008. The Committee hopes that the Government will be in a position to inform it in its next report that the workers of the abovementioned enterprise have been reinstated in their rights pertaining to sickness insurance.

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The Committee notes that the Government’s report contains no reply to its previous comments. It hopes that the next report will include full information on the matters raised in its previous direct request, which read as follows:

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.).

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The Committee notes that the Government’s report contains no reply to its previous comments. It must therefore repeat its previous observation, which read as follows:

Non-payment of social security contributions by the company Intercontinental de Aviación. The Committee notes the information provided by the Government in its report in reply to the observations made in 2003 by the Colombian Association of Civil Pilots (ACDAC) concerning the non-payment of social security contributions by the company Intercontinental de Aviación in relation to its employees. It notes, in this respect, that an inspection of the above company carried out in July 2004 ascertained the failure to pay social security contributions for the period 1998 to 2004. The Government adds that the company has since been closed by order of the Civil Aviation Administrative Department and that the retroactive payment has been ordered of the sums due in respect of contributions to the global social security scheme. The Committee notes this information and requests the Government to continue to keep it informed of the outcome of this matter and, in particular, of the situation of the workers of the above company in relation to health insurance for both the period prior to the closure of the company and the period since then. The Committee also takes the opportunity to request the Government to indicate the measures that have already been taken or are envisaged to ensure greater compliance in future with the obligations deriving from the Convention and to prevent such clear cases of non-compliance persisting over such long periods.

The Committee hopes that the Government will make every effort to take the necessary action in the very near future.

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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.).

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Non-payment of social security contributions by the company Intercontinental de Aviación. The Committee notes the information provided by the Government in its report in reply to the observations made in 2003 by the Colombian Association of Civil Pilots (ACDAC) concerning the non-payment of social security contributions by the company Intercontinental de Aviación in relation to its employees. It notes, in this respect, that an inspection of the above company carried out in July 2004 ascertained the failure to pay social security contributions for the period 1998 to 2004. The Government adds that the company has since been closed by order of the Civil Aviation Administrative Department and that the retroactive payment has been ordered of the sums due in respect of contributions to the global social security scheme. The Committee notes this information and requests the Government to continue to keep it informed of the outcome of this matter and, in particular, of the situation of the workers of the above company in relation to health insurance for both the period prior to the closure of the company and the period since then. The Committee also takes the opportunity to request the Government to indicate the measures that have already been taken or are envisaged to ensure greater compliance in future with the obligations deriving from the Convention and to prevent such clear cases of non-compliance persisting over such long periods.

The Committee is also raising other matters in a request addressed directly to the Government.

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The Committee notes that the Colombian Association of Civil Pilots (ACDAC) has made observations on the application of the Convention and invites the Government to reply to them in its next report.

The Committee wishes to point out that this comment only covers the observations made by the above workers’ organization under article 23 of the Constitution and reminds the Government that it is asked to reply in its next report to the comments made in 2002 on the application of the Convention in general.

[The Government is asked to reply in detail to these comments in 2004.]

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The Committee notes the information contained in the Government’s last report and the many legislative texts attached. The Committee however notes that the Government has not provided detailed information on the impact of the legislation as a whole respecting the new General Social Security Health System (SGSSS) on the application of each of the Articles of the Convention. It requests it to provide such information in its next detailed report. The Committee also wishes to draw the Government’s attention to the following points.

Article 2 of the Convention. In reply to the Committee’s previous comments on the geographical coverage of the contributory scheme of the SGSSS, the Government indicates that the number of persons paying contributions to this scheme was 5,631,268 in the month of December 1999, and that all workers bound by a contract of employment contribute to the scheme. The Committee notes this information and requests the Government to continue providing 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 notes that, under the terms of section 3 of Decree No. 047 of 19 January 2000, in the event of temporary incapacity for work as a result of illness, the provision of cash benefits is subject to a period of contribution of four weeks. It once again 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 to 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.).

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With reference to its observation concerning the adoption of the new general social security system for health care, established by Act No. 100 of 1993, as amended by Decree No. 1298 of 22 June 1994, and the regulations issued thereunder (Decrees Nos. 1919 and 1938 of 1994), the Committee requests the Government to provide detailed information on the following points.

Article 3, paragraph 1, of the Convention. The Committee notes that under section 11 of Decree No. 1938 of 5 August 1994 and section 8(b) of Decree No. 1919 of 5 August 1994, the Compulsory Health Plan (POS) provides for the award of cash benefits to persons insured under the contributory scheme in the event of temporary incapacity resulting from a general disease. In this respect, the Committee would be grateful if the Government would specify the amount of these benefits and the period during which they can be provided, with an indication of the legal provisions that are applicable.

Article 3, paragraph 2. The Committee requests the Government to indicate whether and, if so, under which provisions, the payment of a cash benefit in the event of temporary incapacity for work as a result of sickness is subject to the completion of a qualifying period.

See also under Article 4, paragraph 1, point 2(b) below.

Article 4, paragraph 1. (1) The Committee notes that, in accordance with section 2(f) of Decree No. 1919 of 1994, the Compulsory Health Plan guaranteed by the health care providers (EPS) to their insured persons includes preventive, medical and surgical care, rehabilitation and the provision of essential medicines. Section 3(b) of Decree No. 1938 of 1994 specifies that the procedures for the provision of these health benefits are governed by manuals of procedure and guidelines for integral assistance established by the Ministry of Health. The Committee would be grateful if the Government would supply detailed information in its next report on the nature of the care guaranteed by the POS and copies of the above manuals and guidelines adopted by the Ministry of Health. The Committee also requests the Government to indicate the period of which the medical care supplied in the context of the POS is provided to workers.

(2) The Committee recalls that Article 4, paragraph 1, does not provide for the possibility of submitting entitlement to medical care to the completion of a waiting period. In this respect, it wishes to draw the Government's attention to the following points.

(a) The Committee notes that section 26 of Decree No. 1938 establishes minimum periods of contribution for entitlement to care required for the treatment of high-cost diseases: 100 weeks of contribution for diseases classified as catastrophic or ruinous under level IV of the POS and 52 weeks for diseases needing surgery of an "optional nature", as from 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. In these conditions, the Committee hopes that the Government will be able to re-examine the matter in the light of Article 4, paragraph 1, of the Convention and will indicate the measures which have been taken or are envisaged to abolish, or at least in the first stage to reduce these waiting periods, which are particularly long. Please also indicate whether the completion of these waiting periods is required each time that a worker changes EPS. The Committee also requests the Government to provide the list of diseases for which the treatment is subject to the completion of one of the above waiting periods and the medical acts concerned. Finally, it would be grateful if the Government would provide information on the effect given in practice to the above provisions and on the measures which have been taken or are envisaged to give effect to Article 4, paragraph 1, in the case of workers who do not have sufficient financial means to pay the proportion of the medical expenses which corresponds to the remaining weeks of contribution.

(b) Furthermore, the Committee notes that, in accordance with section 24 of Decree No. 1938 of 1994, 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. Furthermore, in cases where workers have been insured under the same EPS for six months, they benefit from a supplementary four-week period of protection after the date on which their contract with the EPS comes to an end. However, during this period of protection, care is only provided for diseases which are currently being treated or which are of an urgent nature (section 25 of the Decree). In these conditions, the Committee requests the Government to indicate whether workers who decide to leave the Social Security Institute to become insured under an EPS or to change EPS must once again wait four weeks to be entitled to the medical and cash benefits guaranteed by the POS in the case of new diseases or accidents which occurred after changing the insurance scheme.

Article 4, paragraph 2. The Committee notes that, in accordance with section 63 of Decree No. 1298 of 1984, persons who are insured under the general social security system for health care are required to share in the cost of health care in order to rationalize the use of the services provided by the system, although this cost-sharing must not in any event constitute a barrier to access to care for the most impoverished. The Committee would be grateful if the Government would supply additional information in its next report on the mechanisms of this cost-sharing.

Article 6, paragraph 1. (a) The Committee would be grateful if the Government would indicate the manner in which effect is given to this provision of the Convention, in accordance with which sickness insurance shall be administered by self-governing institutions, which shall be under the administrative and financial supervision of the competent public authority and shall not be carried on with a view of profit.

(b) The Committee notes the provisions of Book V of Decree No. 1298 of 1994 respecting the inspection, control and supervision of the general social security scheme for health care, and particularly respecting the National Health Authority. In this respect, it requests the Government to provide detailed information on the manner in which the system, and particularly EPS, are supervised in practice.

Article 6, paragraph 2. Under the terms of section 3(10) of Decree No. 1298, the participation of representatives of the organizations of the persons protected is compulsory in the administrative bodies of public entities. Furthermore, the Committee notes that section 8(5) of the above Decree guarantees the participation of insured persons, either individually or through their organizations, in all the assemblies and representative and inspection mechanisms of entities which manage, promote and provide health services under the general social security scheme (see also sections 5(h) and 42 of the Decree). It would be grateful if the Government would indicate how the participation of insured persons is guaranteed in practice in the management of the system, and particularly EPS.

Article 9. The Committee requests the Government to indicate whether and under which provisions, the legislation recognizes a right of appeal to insured persons in the event of disputes concerning their entitlement to health care benefits, in accordance with this provision of the Convention.

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The Committee notes the adoption of the new general social security system for health care, for which the structure and rules are established by Act No. 100 of 1993 on the social security system, as amended by Decree No. 1298 of 22 June 1994 and the regulations issued thereunder (Decrees Nos. 1919 and 1938 of 1994). The objective of the system is to establish conditions under which the whole population has access to the public health service. Health Care Providers (EPS) are responsible for the affiliation and registration of insured persons and the collection of contributions. In exchange, they are under the obligation to provide insured persons with the benefits guaranteed under the Compulsory Health Plan (POS) either directly or through institutions which provide health care services. The EPS may be public bodies, such as the Social Security Institute, or private or mixed entities and have to be recognized by the National Health Authority, which is the supervisory and inspection body for the system. Furthermore, workers must be able to freely choose the EPS under which they wish to be insured.

The Committee notes that the Government's latest report only contains general comments on the new health system. In these conditions, it once again requests the Government to supply detailed information on the impact of the new legislation on each of the Articles of the Convention.

With particular reference to Article 2 of the Convention, the Committee has been drawing the Government's attention for a number of years to the need to extend the application of the legislation giving effect to the Convention to the whole of the national territory. In its latest report, the Government states that the objective of the health branch of the general social security system established by Act No. 100 of 1993 is to enable all residents on the national territory to have access to the Compulsory Health Plan by the year 2001. In these conditions, the Committee would be grateful if the Government would provide statistical information on the coverage in practice of the general social security system in the field of health care as regards the contributory scheme and if it would indicate in particular the percentage of workers covered by the Convention who benefit from the POS in the context of the contributory scheme in relation to the total number of such workers.

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The Committee notes the information supplied by the Government in its report. It also notes the adoption of Act No. 100 of 23 December 1993 establishing an integrated social security system, of Decree No. 1298 of 22 June 1994 enacting the organic status of the general social security system on health as well as various other texts under Act No. 100. The Committee requests the Government to supply in its next report further information on the entry into force of this legislation in regard to sickness insurance and its implementation in practice. It would like, in particular, the Government to provide detailed information for each of the Articles of the Convention in regard to medical care and sickness benefits.

With respect more particularly to Article 2 of the Convention, the Committee hopes that the Government's next report will contain detailed information on the geographical extension of the integrated social security scheme in order to ensure that all workers covered by the Convention benefit from sickness insurance.

[The Government is requested to report in detail in 1997.]

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Article 4, paragraph 1, of the Convention. The Committee notes the information supplied by the Government in reply to its previous comments concerning the requirement of a prior period of contribution for medical assistance to be granted whereas such a requirement is not provided for in Article 4, paragraph 1, of the Convention. It recalls that this question is not related to beneficiaries' possible participation in the cost of medical benefit, which is dealt with in paragraph 2 of Article 4. In these circumstances and in view of the relatively short qualifying period (four weeks of contribution) prescribed in section 8 of Decree No. 770 of 30 April 1975 (General Sickness and Maternity Insurance Regulations), the Committee expresses the hope that the Government will have no difficulty in abolishing any prior period of contribution for the grant of medical assistance, for example when the above-mentioned General Sickness and Maternity Insurance Regulations are reviewed. It would be grateful if the Government would provide information on progress made in this respect.

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With reference to its previous observation, the Committee hopes that the Government will provide detailed information in its next report on progress made in extending social security to more municipalities so that all workers covered by the Convention throughout the national territory are guaranteed the benefits of sickness insurance, in accordance with Article 2 of the Convention.

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Article 4, paragraph 1, of the Convention. The Committee takes note of the Government's reply to its previous comments in which it states that it will examine with the Social Insurance Institute and employers and workers, ways in which it would be possible to abolish the prior period of contribution of four weeks from which the provision of assistance and cash benefits to the worker is conditional.

The Committee notes the above information with interest and hopes that the examination of the point in question will result in the abolition of the four-week qualifying period, prescribed in section 8 of Decree No. 770 of 30 April 1975 (General Sickness and Maternity Insurance Regulations), which is contrary to Article 4, paragraph 1, of the Convention, which does not authorise any qualifying period for the provision of medical assistance.

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The Committee notes the information supplied by the Government in its report, and the information contained in the report of the activities of the Social Insurance Institute (ISS) for 1982-86, and contained in the document "Social Security in Colombia" published by the National Health Institute, which gives a wide-ranging and systematic analysis of the population covered by social security in general and by the ISS in particular. The Committee notes with interest that, according to the Government's indications, both social security coverage for categories of the workforce according to branches of economic activity and geographical coverage have been greatly increased and that the number of municipalities benefiting from coverage is continually rising. The Committee hopes that progress will continue to be made in this direction and requests the Government to supply information in its next report concerning the steps taken in this respect.

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