Historic deficit, chronic disease burden, and lack of transparency: report reveals critical snapshot of the teachers' health system

The Colombian teacher healthcare system is going through a critical period. This is revealed in the second monitoring bulletin on the National Teachers' Social Benefits Fund (FOMAG), presented this Wednesday by the think tank Así Vamos en Salud (As We Go in Health). It warns of a structural financial deficit, transparency issues, and a growing burden of chronic and oncological diseases among the affiliated population.

The report indicates that, as of June 2025, Fomag had more than 826,000 members: 488,770 contributors and 337,510 beneficiaries. The population is predominantly female (60%) and the 45-65 age group, reflecting an aging demographic with high care needs.

This composition places a double burden on the system: children and adolescents among the beneficiaries, who require pediatric and school health services, and older adults with growing needs for chronic and highly complex illnesses.

Fifty percent of the affiliates are concentrated in seven departments—Bogotá, Antioquia, Valle del Cauca, Santander, Córdoba, Atlántico, and Bolívar—which poses challenges in terms of planning and installed capacity in the service provider network.

The bulletin shows a deterioration in the cancer burden among teachers. Eight types of cancer—including cervical, colorectal, breast, and prostate—increased in prevalence and mortality.

In cervical cancer, for example, the mortality rate increased from 1.1 in 2020 to 3.5 in 2024, and the prevalence from 55.1 to 84.9. Breast cancer mortality doubled in the same period, and prostate cancer tripled its recorded deaths.

Overall, cancers became the leading cause of death among teachers in 2024 (957 cases), surpassing cardiovascular disease (845). The report also records sustained growth in HIV prevalence, which increased from 0.12 to 0.27 per 100,000 members between 2020 and 2024.

The timeliness of care is low: in cervical cancer, the average time from suspicion to the start of treatment was 128 days, classified as low adherence.

Fomag currently has 2,561 IPS (Institutionalized Health Services) and 6,032 locations across the country, but with a marked geographic concentration: 80% are located in just 17 departments. Furthermore, 76% of the providers are private and only 23% are public.

The report warns of transparency failures: 13 locations were identified that are not registered with the REPS, which calls into question the reliability of the contracted network.

The analysis of Petitions, Complaints, Claims, and Suggestions (PQRS) shows a significant drop in 2025: 19,440 reports through June, equivalent to 235.2 complaints per 10,000 members, below the national average.

However, Así Vamos en Salud warns that the decrease may be due to improvements in care as well as possible underreporting or barriers to accessing participation mechanisms.

Eighty percent of complaints focus on seven issues: denial or delay in the delivery of medications and technologies, delays in medical appointments, lack of opportunity for specialist consultations, and barriers to accessing high-cost treatments such as chemotherapy, radiotherapy, and hemodialysis.

One of the most critical issues is the structural imbalance between revenue and expenditure. Between 2019 and 2025, healthcare revenue increased from $1.49 trillion to $2.91 trillion, while expenditure increased to $3.47 trillion.

In 2024, the jump was historic: spending rose to $4.8 trillion compared to revenues of just $2.6 trillion, leaving a record deficit of $2.1 trillion (184%). The majority of this spending was concentrated on medical service contracts (60%) and court judgments and settlements (30%).

By 2025, the initial appropriation projects a deficit of $568 billion. However, experts caution that this estimate is optimistic, as the budget does not incorporate adjustments for inflation or the actual increase in medical costs.

Furthermore, inconsistencies persist in financial information: budget catalogs, official records, and financial statements do not always match, limiting traceability and accountability.

Así Vamos en Salud concludes that Fomag is facing a perfect storm: an aging and highly demanding population, sustained growth in high-cost diseases, a fragmented network with access issues, and a structural deficit that compromises financial sustainability.

The think tank urgently called on Fomag and Fiduprevisora ​​to guarantee clear, traceable, and consistent financial reporting, strengthen spending control mechanisms, and ensure adequate resource planning, in order to protect the right to health of more than 800,000 teachers and their families across the country.

Environment and Health Journalist