Las consecuencias del neoliberalismo. Colombia: prueba in vivo de la privatización del sector salud en países en desarroll

Tony De Groote; Pierre De Paepe; Jean-Pierre Unger

doi:10.17533/udea.rfnsp.217

Authors

Tony De Groote Public Health Department
Pierre De Paepe Public Health Department
Jean-Pierre Unger Public Health Department

DOI:

https://doi.org/10.17533/udea.rfnsp.217

Keywords:

Colombia, health reform, privatization, social segurity

Abstract

The reform of the Colombian health sector in 1993 was founded on the internationally advocated paradigm of privatization of health care delivery. Taking into account the lack of empirical evidence for the applicability of this concept to developing countries and the documented experience of failures in other countries, Colombia tried to overcome these problems by a theoretically sound, although complicated, model. Some ten years after the implementation of “Law 100,” a review of the literature shows that the proposed goals of universal coverage and equitable access to high-quality care have not been reached. Despite an explosion in costs and a considerable increase in public and private health expenditure, more than 40 percent of the population is still not covered by health insurance, and access to health care proves uncreasingly difficult. Furthermore, key health indicators and disease control programs have deteriorated. These findings confirm the results in other middle- and low-income countries. The authors suggest the explanation lies in the inefficiency of contractingout, the weak economic, technical, and political capacity of the Colombian government for regulation and control, and the absence of real participation of the poor in decision-making

on (health) policies.

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References

(1). Human Development Network. Health, Nutrition and Population. Washington, D. C.: Sector Strategy Pap er. World Bank; 1997.

(2). WHO. The World Health Report 2000—Health sys-tems: improving performance. Ginebra: Organiza-ción Mundial de la Salud; 2000.

(3). COM. Communication from the Commission to the Council and the European Parliament: Health and Poverty Reduction in Developing Countries, p. 129. Brussels: Commission of the European Communi-ties; 2002.

(4). Human Development Network. Health, Nutrition and Population. Washington, D. C.: World Bank; 1993.

(5). WHO. The World Health Report 1999: Making a Di-fference. Ginebra: Organización Mundial de la Salud; 1999.

(6). Preker AS, Harding A, Girishankar N. The Econo-mics of private participation in health care: new insights from institutional economics. Washington, D. C.: World Bank; 1999.

(7). Sen K, Koivusalo M. Health care reforms and deve-loping countries—a critical overview. Int J Health Plann. Manage 1998;13(3):199–215. DOI: https://doi.org/10.1002/(SICI)1099-1751(1998070)13:3<199::AID-HPM518>3.0.CO;2-1

(8). Colombia. Departamento Nacional de Planeación. Proyecto: Cuentas nacionales en salud de Colom-bia. Síntesis general: aspectos conceptuales, meto-dológicos y principales resultados del periodo 1993-1999. Bogotá D. C.: El Departamento; 2001.

(9). Yepes F, Sánchez L. La reforma del sector de salud en Colombia: ¿un modelo de competencia regulada? Rev Panam Salud Pública. 2000;8(1/2): 34–41. DOI: https://doi.org/10.1590/S1020-49892000000700022

(10). Berman P, Bossert T. A decade of health sector re-form in developing countries: what have we learned? DDM Report No. 81. Washington, D. C.: Harvard School of Public Health; 2000. www.hsph.harvard.edu/ihsg/ihsg.

(11). Colombia. Congreso. Sistema de seguridad social integral. Diario Oficial No. 41.148, de 23 de diciem-bre de 1993

(12). Pan American Health Organization. Program on Or-ganization and Management of Health Systems and Services. Division of Health Systems and Services Development. Profile of the Health Services System of Colombia; 2002. Diaponible en: www.lachsr.org/documents/healthsystemprofileofcolombia

(13). Colombia Country Management Unit, PREM Sector Management Unit. Latin America and the Caribbean Region.Colombia Poverty Report. Washington, D. C.: World Bank; 2002.

(14). Colombia. Ministerio de Salud. Dirección general de Aseguramiento, Organización Mundial de la Sa-lud y Organización Panamericana de la Salud. Eva-luación integral del equilibrio financiero del sistema general de seguridad social en salud. Bogotá: Di-rección General de Aseguramiento del Ministerio de Salud de Colombia, OMS y OPS; 2001.

(15). Jaramillo J. Evaluación de la descentralización de la salud y la reforma de la seguridad social en Colom-bia. Gac sanit. 2002; 16(1): 48–53. DOI: https://doi.org/10.1016/S0213-9111(02)71632-4

(16). Céspedes J, Jaramillo I, Martínez R, Olaya S. Efec-tos de la reforma de la seguridad social en salud en Colombia sobre la equidad en el acceso y la utiliza-ción de servicios de salud. Rev Salud Pública. 2000; 2(2): 145-64

(17). Plaza B, Barona A, Hearst N. Managed competition for the poor or poorly managed competition? Les-sons from the Colombian health reform experience. Health Policy Plan. 2001; 16 Suppl 2: 44–51. DOI: https://doi.org/10.1093/heapol/16.suppl_2.44

(18). Félix M, Robayo G, Valencia O. Hygeia no es Pa-nacea: condiciones para dialogar sobre cobertura de la seguridad social en salud. Rev Salud Pública. 2002; 4(2): 103–19.

(19). Hernández, M. Reforma sanitaria, equidad y de-recho a la salud en Colombia. Cad Saúde Pública. 2002; 18(4): 991–1001. DOI: https://doi.org/10.1590/S0102-311X2002000400007

(20). Yepes A. The violation of social rights within mar-ket rationale. En: Social Watch. Annual Report 2003. Montevideo: Social Watch; 2003.

(21). Manning WG, Newhouse JP, Duan N, Keeler EB, Leibowuitz A, Marquis MS. Health insurance and the demand for medical care: evidence from a randomized experiment. Am Econ Rev. 1987;77(3): 251–77.

(22). Profamilia. Encuesta nacional de demografía y salud (ENDS)—Salud sexual y reproductiva en Colombia 2000. Bogotá: Profamilia; 2000.

(23). Van Lerberghe W, De Brouwere V. Assessment of appropriate child care at district level: how useful are mortality rates? Trans R Soc Trop Med Hyg.1989 ;83(1): 23–6 DOI: https://doi.org/10.1016/0035-9203(89)90692-5

(24). Rutstein D, Barenberg W, Chalmers TC, Child CG, Fishman AP, Perrin EB. Measuring the quality of medical care: a clinical method. N Engl J Med. 1976;294(11): 582–8. DOI: https://doi.org/10.1056/NEJM197603112941104

(25). Westerling, R. Commentary: evaluating avoidable mortality in developing countries—An important issue for public health. Int J Epidemiol. 2001; 30(5): 973–75. DOI: https://doi.org/10.1093/ije/30.5.973

(26). Ayala C, Kroeger A. La reforma del sector salud en Colombia y sus efectos en los programas de control de tuberculosis e inmunización. Cad Saúde Pública. 2002; 18(6): 1771–81. DOI: https://doi.org/10.1590/S0102-311X2002000600032

(27). Málaga H, Cárdenas J, Montiel H, Sampson C, De Taborda M. Equidad y reforma en salud en Colom-bia: X Jornadas Colombianas de Epidemiología. Bol. APS. 2001; 6(10): 80–98.

(28). Jaramillo I. El futuro de la salud en Colombia: la puesta en marcha de la ley 100.Bogotá: Tercer Mundo; 1997.

(29). Málaga H, Cárdenas J, Montiel H, Sampson C, De Taborda M. Equidad y reforma en salud en Colom-bia: X Jornadas Colombianas de Epidemiología. Bol APS 2001; 6(10): 80–98.

(30). Kroeger, A., Ordonez-Gonzalez, J., and Avina, A. I. Malaria control reinvented: health sector reform and strategy development in Colombia. Trop Med Int Health. 2002;7(5): 450–8. DOI: https://doi.org/10.1046/j.1365-3156.2002.00876.x

(31). Rueda G. La tuberculosis en Colombia: a propósito del Día Mundial de la Tuberculosis 24 de marzo 1882–2003 (editorial). Repert med Cir. 2003;12 (2). Dispomible en: www.medilegis.com/Banco-Conocimiento/R/RepertorioV12-No2-Editorial/Editorial.htm. DOI: https://doi.org/10.31260/RepertMedCir.v12.n2.2003.314

(32). Uplekar M, Pathania V, Raviglione M. Private prac-titioners and public health: Weak links in tuberculo-sis control. Lancet. 2001; 358(9285): 912–16. DOI: https://doi.org/10.1016/S0140-6736(01)06076-7

(33). Lonnroth K, Thuong LM, Linh PD, Diwan VK. De-lay and discontinuity—a survey of TB patients’ sear-ch of a diagnosis in a diversified health care system. Int J Tuberc Lung Dis.1999;3(11): 992–1000.

(34). Unger, J. P., De Paepe, P., and Green, A. A code of best practice for disease control programmes to avoid da-maging health care services in developing countries. Int J Health Plann Manage. 2003; 18: S27–S39. DOI: https://doi.org/10.1002/hpm.723

(35). Broomberg J. Managing the health care market in developing countries: prospects and problems. Health Policy Plan. 1994; 9(3): 237–51. DOI: https://doi.org/10.1093/heapol/9.3.237

(36). Labelle R, Stoddart G, Rice T. A re-examination of the meaning and importance of supplier-induced demand. J. health econ. 1994;13(3): 347–68. DOI: https://doi.org/10.1016/0167-6296(94)90036-1

(37). Tabbush V, Swanson G. Changing paradigms in medical payment. Arch Intern Med. 1996; 156(4): 357–60. DOI: https://doi.org/10.1001/archinte.156.4.357

(38). Van Lerberghe W, Ammar W, Rashidi R, Sales A, Mechbal A. Reform follows failure: I. Unregulated private care in Lebanon. Health Policy Plan. 1997;12(4): 296–311. DOI: https://doi.org/10.1093/heapol/12.4.296

(39). Bloom, G. Primary health care meets the market in Chi-na and Vietnam. Health policy. 1998;44(3): 233–52. DOI: https://doi.org/10.1016/S0168-8510(98)00019-0

(40). Xu K, Evans D, Kawabata K, Zeramdini, Klavus J, Murray C.Household catastrophic health ex-penditure: A multicountry analysis. Lancet. 2003; 362(9378): 111–7. DOI: https://doi.org/10.1016/S0140-6736(03)13861-5

(41). Gutiérrez C, Molina C, Wüllner A. Las formas de contratación entre prestadores y administradores de salud: sus perspectivas en el nuevo marco de la seguridad social. Bogotá: Guadalupe; 1996.

(42). Van Lerberghe W, Lafort Y. The Role of the Hospi-tal in the District. Ginebra: Organización Mundial de la Salud; 1990. SHS Paper No. 2. WHO/SHS/CC/90.2.

(43). Woolhandler S, Campbell T, Himmelstein DU. Health care administration in the United States and Canada: Micromanagement, macro costs. Int J Health Serv. 2004; 34(1): 65–78 DOI: https://doi.org/10.2190/MJJW-GA0V-78KT-9RGX

(44). Refugees by Numbers 2002 Edition, United Nations High Commissioner for Refugees, July 2002. Quo-ted by Refugee Council, “UK ‘not burdened by re-fugees’”, BBC News, 27 December 2002.

(45). World Bank. World Development Report 1998/1999: Knowledge for Development. Washington, D. C.: Oxford University Press; 1999.

(46). Bossert T, Hsiao W, Barrera M, Alarcon L, Leo M, Casares C. Transformation of ministries of health in the era of health reform: the case of Colombia. Health policy plan. 1998;13(1): 59–77. DOI: https://doi.org/10.1093/heapol/13.1.59

(47). Stocker K, Waitzkin H, Iriart C. The exportation of managed care to Latin America. N Engl J Med. 1999;340(14): 1131–6. DOI: https://doi.org/10.1056/NEJM199904083401425

(48). Restrepo, H. E., and Valencia, H. Implementation of a new health system in Colombia: is this favourable for health determinants? J Epidemiol Community Health. 2002;56(10): 742–43.} DOI: https://doi.org/10.1136/jech.56.10.742

(49). Van Ger Gaag J, Barham T. Health and health ex-penditures in adjusting and non-adjusting countries. Soc Sci Med 1998; 46(8): 995–1009. DOI: https://doi.org/10.1016/S0277-9536(97)10019-3

(50). Figueras J, Saltzman RB. Building upon comparati-ve experience in health system reform. Eur J Public Health. 1998; 8: 99–101. DOI: https://doi.org/10.1093/eurpub/8.2.99

(51). Mills, A. Improving the efficiency of public sector health services in developing countries: bureaucra-tic versus market approaches. En: Colclough C. edi-tor. Marketizing education and health in developing countries: miracle or mirage? Oxford: Clarendon Press; 1997.

(52). McPake B, Hongoro C. Contracting out of clinical ser-vices in Zimbabwe. Soc Sci Med 1995;41(1): 13–24. DOI: https://doi.org/10.1016/0277-9536(94)00303-B

(53). Brugha R, Zwi A. Improving the quality of priva-te sector delivery of public health services: cha-llenges and strategies. Health Policy Plan. 1998; 13(2): 107–20. DOI: https://doi.org/10.1093/heapol/13.2.107

(54). Paredes P et al. Factors influencing physicians’ prescribing behaviour in the treatment of childhood diarrhoea: Knowledge may not be the clue. Soc Sci Med. 1996; 42(8): 1141–53. DOI: https://doi.org/10.1016/0277-9536(95)00387-8

(55). Kumaranayake. L. The role of regulation: influen-cing private sector activity within health sector re-form. 1998;9(4): 641–49. DOI: https://doi.org/10.1002/(SICI)1099-1328(199706)9:4<641::AID-JID473>3.3.CO;2-#

(56). Mills A. To contract or not to contract? Issues for low and middle income countries. Health Policy Plan. 1998;13(1): 32–40. DOI: https://doi.org/10.1093/heapol/13.1.32

(57). Broomberg J. Health Care Markets for Export? Les-sons for developing countries from European and American experience. LSHTM, Londres, 1994.

(58). Criel B, Van Dormael M. Mutual health organiza-tions in Africa and social health insurance systems: Will European history repeat itself? (editorial). Trop Med IntHealth. 1999;4(3): 155–9. DOI: https://doi.org/10.1046/j.1365-3156.1999.43385.x

(59). Haubert M. Frelin C. Leimdorfer F. États et société dans le tiers-monde: de la modernisation à la démocratisation? Paris: Publications de la Sorbonne; 1992.