Abstract This article formulates possible future scenarios for the Colombian General Health and Social Security System (GHSSS) in 2033 when it reaches its 40th anniversary. The research draws on intuitive logic from the School of Human and Social Foresight (Masini, Penser le futur, 2000). The approach considers that in contexts of high instability and high conflict of interests, a combination of methods is required for the analysis of relevant transformations. It entails applying methods based on evidence, expertise, interaction, and creativity as discussed by Keenan and Popper (Foresight 10:16–36, 2008). Three scenarios are devised with the participation of real actors representing a plurality of visions from the public, private, academic, and social sectors. Finally, two future scenarios are featured, the one chosen by the experts before the triumph of the current government and the one that the Ministry of Health will present to the Colombian Congress for approval in 2023.