Figure 2 shows the distribution of health care systems by income decile, differentiating all such contributory health system workers with incomes below 10 monthly minimum wages and their beneficiaries, from those with incomes above 10 monthly minimum wages.

<!-- Start of picture text --> FIGURE 2: DISTRIBUTION OF HEALTHCARE SYSTEMS IN COLOMBIA BY INCOME DECILE<br>100<br>Scheme: No information<br>80<br>Scheme: Special<br>60<br>Scheme: Contributory (more than<br>40<br>10 SMMLV)<br>20 Scheme: Contributory (less than 10<br>SMMLV)<br>0<br>Scheme: Subsidized<br>1 2 3 4 5 6 8 7 9 10<br>Decile<br>Source: World Bank Group and staff estimates based on the 2017 ENPH<br>Note: The deciles were put together using market income + per-capita pensions<br><!-- End of picture text --> Given the particularity of the Colombian health care system, there are three scenarios for the treatment of transfers in kind for health services. In the first scenario, it is assumed that only workers belonging to the subsidized health care system** receive a transfer in kind for health services. The following two scenarios consider that given the CREE tax (tax with specific allocation) was eliminated, and currently, the national government uses resources from the National General Budget to make transfers of money shortfalls to the contributory healthcare system. Therefore, these funds must be treated as a national government transfer, similar to pensions.

Thus, in the second scenario, in addition to considering the persons belonging to the subsidized health care system, all employees who belong to the contributory health care system but who have incomes below 10 monthly minimum wage are included. In other words, it is assumed that all such employers of workers with incomes below 10 smmlv [monthly minimum wage] do not make any direct contribution to the health care system. This makes employees potentially eligible for a transfer in kind for health services. Thus, the transfer received by the workers is equivalent to 68 percent *** of the contributory health system's UPC.

The last scenario considers that even when employers do not make direct contributions, there are employees whose contribution exceeds the cost of health services, while there are some other employees whose contributions do not cover the cost of health services, and therefore receive a transfer from the national government. Thus, for example, in the case of two workers, one with a monthly salary of 1,000,000, while the other receives a monthly salary of 7,000,000. The contribution to the health care system of these workers per year is 4 percent of their annual salary. In the case of the first worker, their contribution totals 480,000, while the second worker makes contributions worth 3,360,000. The average cost of a person enrolled in the contributory health system in 2017 was 1,070,281.66 Colombian pesos. In our example, the contributions made by the first worker are insufficient to cover the average cost of the average health cost, while the contributions of the second worker exceed the average cost of the same. It should be noted that for 87 percent of people belonging to the contributory health system, whose contributors have incomes below 10 smmlv, the contributions made to the health care system are lower than the cost of services received by the entire family group.

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