Abstract Objectives To explore and explain the perceptions that Colombians have about voluntary private health insurance plans (VPHI) in the health system to identify the tensions that exist between the public and private systems. Methods A case study with semistructured interviews of patients, healthcare workers, healthcare administrators, decision-makers, and citizens. Results Based on interviews with 46 participants, we developed a paradigmatic matrix that explains how, in a context mediated by both the commodification of health and social stratification, failures in the public health system related to lack of timely care, extensive administrative procedures, and the search for privileged care led to positioning VPHI as a solution to these failures. The interviewees identified three consequences of using VPHI: first, the worsening of problems of timely access to care in the public system; second, higher costs for citizens translated into double payment for technologies and services to which they are entitled; third, the widening of inequity gaps in access to health services between people with similar needs but different payment capacities. Conclusions These findings can help decision makers to dimension the direct and indirect effects generated by the growth of VPHI and complement analyses of how private insurance, instead of solving the problem of timely access to care, may contribute to increasing it and worsening equity gaps in health in the country.