Dating back to 1992, healthcare in Colombia is characterized by a managed competition model, where citizens may choose between one of the health insurance companies. Insurers are financed by premiums and tax revenues. Healthcare services are largely provided by private care providers, but there are also public hospitals. Access to secondary care is dependent on a GP referral and the insurer’s authorization. Remuneration of services (emergency care excepted) depends on a contract between provider and insurer. Services are usually contracted on a fee-for-services basis, in some areas a fee per capita is used. The Colombian healthcare system recently has made significant advances, for example regarding universal coverage (covering more than 95.6 per cent of the population). Some serious challenges remain, notably regarding a clearer delineation of the coverage, an increase of insurer’s financial sustainability and actual or potential anticompetitive behaviour.