From Few to Many

Ten Years of Health Insurance Expansion in Colombia

From Few to Many is the first comprehensive look at Colombia’s 1993 health system reforms. It describes the implementation of universal health insurance, including a subsidized system for the poor, and examines the impact of this and other reforms during a time when Colombia experienced crushing recession and internal conflict that displaced half a million people.

Prior to the reforms, a quarter of the Colombian population had health insurance. Subsidies failed to reach the poor, who were vulnerable to catastrophic financial consequences of illness. Yet by 2008, 85 percent of the population benefited from health insurance.

From Few to Many describes the challenges and benefits of implementing social health reforms in a developing country, exploring health care financing, institutional reform, the effects of political will on health care, and more. The reforms have provided important lessons not only for continued reform in Colombia, but also for other nations facing similar challenges.


“Among the efforts to achieve universal health insurance coverage in low- and middle-income countries, Colombia stands out both for the long interval of implementation (since 1993) and for the thoroughness with which the experience has been analyzed and evaluated. Everything a researcher or policymaker might want to know about the country’s progress, setbacks and adaptations to changing economic and political circumstances is here in one impressive volume.”
—Philip Musgrove, Deputy Editor, Health Affairs

“Colombia is a researcher’s dream: interesting reforms, exceptionally good data, and an engaging academic and policy community. Yet, little is known about the country because very few publications target the international audience. This book bridges that gap in the case of health reform by underscoring one of the most impressive accomplishments in the developing world. Although the Colombian reform still has many challenges, the book is a tool kit for those interested in improving the efficiency and equity in the delivery of health services.”
—Mauricio Cárdenas, Senior Fellow and Director, Latin America Initiative, The Brookings Institution