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Previous comments: Direct requests C.12, C.17, C.18 and C.19; direct requests C.24 and C.25
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.
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.).
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.
(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).
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.
The Committee is also raising other matters in a request addressed directly to the Government.
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.]
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.
(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).
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.
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.
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.
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.]
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.
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.
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.
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.