The ecology of medical care in Colombia and its relations to socioeconomic factors, 2023

IntroductionThe ecology of medical care framework describes how populations interact with different levels of health services. Despite Colombias formal commitment to primary health care (PHC) and near-universal insurance coverage, limited evidence exists on how health services are actually used across territories and socioeconomic contexts. MethodsAn ecological, cross-sectional study was conducted using national administrative data to describe health service utilization patterns in Colombia during 2023. Data were obtained from official sources, including health service provision records, health workforce registries, insurance affiliation databases, population projections, and socioeconomic indicators. Health service utilization was measured as the number of individuals per 1,000 inhabitants using different levels of care. Associations between utilization rates, socioeconomic characteristics, and physician availability were examined using negative binomial regression models with population size as an offset. ResultsSubstantial heterogeneity in healthcare utilization was observed across municipalities and geographic regions. Most outpatient consultations were provided by non-specialist physicians, with comparatively smaller differences between primary care and specialist consultations. Emergency department visits and hospitalizations showed lower utilization rates overall, although some municipalities exhibited disproportionately high use of these services. Regions with higher poverty levels and unmet basic needs consistently showed lower utilization across most levels of care, while higher educational coverage was positively associated with specialist and inpatient care. ConclusionsThe ecology of medical care in Colombia reveals a health system formally oriented toward primary health care but functionally dependent on non-specialist physicians and characterized by marked territorial and socioeconomic inequities in service use. These findings suggest that universal coverage alone is insufficient to ensure equitable access and effective primary care. Understanding real-world patterns of utilization is essential to inform ongoing health system reforms aimed at strengthening PHC, improving coordination across levels of care, and addressing unmet health needs, particularly in underserved regions.