A growing body of evidence points to a deepening crisis within Colombia’s Nueva EPS, the country’s largest health insurer with 11.5 million members. A recent study conducted by the Valle del Cauca regional government – led by Dr. Víctor Muñoz and the Secretary of Health, Dr. María Cristina Lesmes – investigated the impact of the insurer’s ongoing institutional challenges on its members in that region.
The study sought to determine whether, since July 2025, there had been a differential increase in mortality among Nueva EPS affiliates compared to the rest of the healthcare system in Valle del Cauca. The results reveal a consistent temporal association between the worsening administrative crisis at Nueva EPS and a significant increase in deaths among its users.
According to the report, while the average mortality increase across the departmental health system was 9.6% during the period analyzed, Nueva EPS experienced a rise of 14.1%. This difference of 4.5 percentage points represents a substantial gap. Comparatively, the increase in mortality among Nueva EPS affiliates was 47% higher than that observed in other insurers operating in Valle del Cauca, suggesting an atypical pattern.
Researchers utilized data from the Single Registry of Affiliates – Births and Deaths (RUAF-ND), processed by the Valle del Cauca Departmental Health Secretariat, to support their analysis. The dataset included 97,095 non-fetal deaths of residents in the region, excluding external causes such as traffic accidents, homicides, or injuries due to the lack of EPS registration in those cases.
The central hypothesis of the study, published by Consultor en Salud, posited that systemic failures – such as denial of authorizations, medication shortages, treatment interruptions, and barriers to specialist access – could be linked to an increase in preventable deaths. The study aimed to determine whether these administrative problems extended beyond operational issues to directly impact clinical outcomes.
The observation period encompassed a 30-month baseline, starting in January 2023, compared to seven months categorized as the “crisis period,” spanning from July 2025 to January 2026. This timeframe allowed researchers to reduce potential seasonal biases and compare trends before and after the reported institutional deterioration.
The comparative analysis revealed that the observed phenomenon was not a generalized public health trend in Valle del Cauca, but rather a pattern specifically focused on Nueva EPS. While other insurers maintained a performance close to the historical average, Nueva EPS demonstrated a marked deviation during the critical period.
Upon disaggregating the underlying causes of death, the report found a greater impact on conditions requiring continuous monitoring and a consistent supply of medications or health technologies. Chronic diseases and conditions dependent on strict therapeutic adherence were particularly sensitive to interruptions in care.
According to Dr. Muñoz and Secretary Lesmes, the evidence suggests that continuity of care is a determining factor in patient outcomes. When interrupted due to contractual, financial, or administrative reasons, clinical risk increases and can lead to potentially preventable fatalities with timely attention.
The study concludes that the operational and financial crisis at Nueva EPS had measurable effects during the seven months evaluated, reflected in excess mortality from causes sensitive to the quality of care. The authors emphasize the need for clinical and operational audits to assess risk management and implement immediate corrective measures to protect the lives and health of affiliates.
The situation at Nueva EPS is occurring against a backdrop of broader challenges within Colombia’s healthcare system. A 2016 report exploring health care coverage in Colombia highlighted a gap between formal and material access to care, particularly for those in poorer regions. While legal coverage has expanded rapidly, access to actual services remains unevenly distributed. This disparity has led to a significant number of citizens filing lawsuits – known as tutelas – demanding access to medications and treatments covered by the health system but denied by insurance companies (EPS).
Further exacerbating the situation, several EPS, including Nueva EPS, Emssanar, Asmet Salud, Coosalud, and SOS, have been placed under government intervention due to substantial debt. These insurers collectively hold the majority of affiliations in Valle del Cauca, and their accumulated debts are contributing to the current crisis, leading to delayed appointments and interrupted treatments.
The findings from Valle del Cauca raise serious concerns about the potential for wider systemic issues within Colombia’s healthcare financing and delivery. The study underscores the critical importance of ensuring uninterrupted access to care, particularly for patients with chronic conditions, and the need for robust oversight of health insurance providers to prevent similar crises from unfolding elsewhere.
