Impact of COVID-19 on healthcare utilization, cases, and deaths of citizens and displaced Venezuelans in Colombia: Complementary comprehensive and safety-net systems under Colombia’s constitutional commitment

Donald S. Shepard, Adelaida Boada, Douglas Newball-Ramirez, Anna G. Sombrio, Carlos William Rincon Perez, Priya Agarwal-Harding, Jamie S. Jason, Arturo Harker Roa, Diana M. Bowser


This article assesses the impact of COVID-19 on healthcare utilization and health outcomes of Venezuelan migrants in Colombia, compared to Colombian citizens. Colombia hosts an estimated 1.8 million displaced Venezuelans, mostly located in large cities such as Bogotá, Barranquilla, Cúcuta, and Medellín. 

Any person in Colombia (citizen or migrant) is entitled to limited lifesaving or safety net services, which are largely hospital services. Additionally, citizens and officially registered foreigners are entitled to register for health insurance under the country’s national health system, which enables them to access comprehensive services, which are largely consultations with a medical professional. For Venezuelans, enrollment in an insurance plan requires authorization, documentation, and an understanding of the requisite administrative process.  

The authors analyze access to health care for displaced Venezuelans and Colombian citizens before and during the COVID-19 pandemic, rates of hospitalization, consultation, and COVID-19 cases, and deaths. The analysis is based on: (1) data on COVID-19 cases and deaths from the Sistema Nacional de Vigilancia en Salud Pública (SIVIGILA); (2) data on healthcare utilization from the Registro Individual de Prestación de Servicios (RIPS); and (3) the national census.  

Main results: 

  • Colombians had higher reported COVID-19 case rates than Venezuelans 
  • Colombians had higher COVID-19 death rates than Venezuelans, and the gap widened during the first year of the pandemic. The adjusted age-standardized death rates of Venezuelans were 78 percent below the corresponding Colombians’ rates in 2019 and 84 percent below in 2020.  
  • Colombians had higher hospitalization rates than Venezuelan migrants, and the gap narrowed in the first year of the pandemic. In 2019, hospitalization rates for Venezuelans were 45 percent below Colombians, and by 2020, the gap had decreased to 35 percent. 
  • Colombians had higher rates of consultations compared to Venezuelans. In 2019, Venezuelans’ consultation rates were 87 percent below those of Colombians, and by 2020 the gap had reduced slightly to 86 percent. 

 Venezuelans had lower COVID-19 case rates and death rates compared to Colombians, suggesting a potential “healthy migrant effect” and access to life-saving treatment through Colombia’s safety-net healthcare system. Colombians were far likelier to be in the contributory insurance regime, which ensured access to comprehensive care.  

The authors suggest a number of policy changes to further integrate migrants into Colombia’s healthcare system, including: assisting Venezuelans to become official residents, strengthening health promoters, adjusting metrics for assessing quality of care, creating responsible units in local government to assist displaced Venezuelans, reducing discrimination against Venezuelans, and seeking greater financial responsibility from international donors in providing health services to migrants and refugees in Colombia.