Tensions over what to include and who to cover in the Colombian health care system from the perspective of a group of citizens
DOI:
https://doi.org/10.17533/udea.rfnsp.e356278Keywords:
access to health services, government financing, health service needs and demands, citizen participation, health systemAbstract
Objective: This study aims to explore and understand the perceptions of a group of citizens on health technologies and services that should be financed with public resources.
Methods: A qualitative case study was used. Information was collected through semi-structured interviews with 46 participants in five population groups (people with no recent contact with health services, patients, health workers, administrators and decision makers). Subsequently, a thematic analysis was carried out.
Results: Two approaches to financing health technologies and services with public resources were identified. One approach conditions it on 1) the characteristics of those who need care, 2) the disease they suffer, 3) the technology or service required, and 4) the expectation of efficient performance of the health system, determining coverage according to the economic conditions and social vulnerability of the person, the urgency of care or evidence of effectiveness. The other approach considers full coverage of technologies and services for all Colombians, based on principles of human dignity, right to health and honest use of resources.
Conclusions: The approaches identified respond to social tensions related to the structure of the health system and its organization in the provision of services. The three most important tensions are those related to the economic capacity of the citizen, the perspective that defines the health-illness concept, and the meanings of effectiveness and scientific evidence.
Downloads
References
Herzog L, Lepenies R. Citizen science in deliberative systems: Par-ticipation, epistemic injustice, and civic empowerment. Minerva. 2022;60:489-508. DOI: https://doi.org/10.1007/s11024-022-09467-8
Kishimoto K, Kobori H. COVID-19 pandemic drives changes in participation in citizen science project “City Nature Challenge” in Tokyo. Biol Conserv. 2021;255:109001. DOI: https://doi.org/10.1016/J.BIOCON.2021.109001
Chen Q, Min C, Zhang W, et al. Unpacking the black box: How to pro-mote citizen engagement through government social media during the COVID-19 crisis. Comput Human Behav. 2020;110:106380. DOI: https://doi.org/10.1016/J.CHB.2020.106380
Chan EYY, Gobat N, Dubois C, et al. Bottom-up citizen engage-ment for health emergency and disaster risk management: Direc-tions since COVID-19. Lancet. 2021;398(10296):194-6. DOI: https://doi.org/10.1016/S0140-6736(21)01233-2
Aldret AD. Participación ciudadana en la gestión y en las políti-cas públicas. Gest. Polít. Pública [internet]. 2017 [citado 2024, abr. 24] ;26(2):341-79. Disponible en: https://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1405-10792017000200341
De Weger E, Drewes HW, Van Vooren NJE, et al. Engaging citizens in local health policymaking. A realist explorative case-study. PLoS One. 2022;17(3):e026540. DOI: https://doi.org/10.1371/journal.pone.0265404
Nabarette H, Chastenay MH, Dupont JCK, et al. Patient and citi-zen participation at the organizational level in health technolo-gy assessment: An exploratory study in five jurisdictions. Int J Technol Assess Health Care. 2023;39(1):e51. DOI: https://doi.org/10.1017/S0266462323000417
Rueda Rodríguez B. La efectividad de la particpación desde la ex-periencia de las instancias deliberativas locales en Bogotá. Rev Relac Int Estrateg y Segur [internet]. 2018 [citado 2024 abr. 24]; 7(2):131-55. Disponible en: https://revistas.unimilitar.edu.co/in-dex.php/ries/article/view/85/1720
Velásquez FE. La participación ciudadana en Bogotá: entre la insti-tucionalización y la movilización. Cidur [internet]. 2014:71-102. [citado 2024 abr. 24]. Disponible en: http://www.scielo.org.co/pdf/rci/n71/n71a05.pdf
Delgado Gallego ME, Vázquez Navarrete ML, et al. Participación social en salud: conceptos de usuarios, líderes comunitarios, ges-tores y formuladores de políticas en Colombia. Una mirada cuali-tativa. Rev Esp Salud Pública. 2005;79(6):697-707. DOI: https://doi.org/10.1590/s1135-57272005000600009
Mosquera M, Zapata Y, Lee K, et al. Strengthening user partici-pation through health sector reform in Colombia: A study of ins-titutional change and social representation. Health Policy Plan. 2001;16(Supl. 2):52-60. DOI: https://doi.org/10.1093/HEA-POL/16.SUPPL_2.52
Colombia, Congreso de la Republica. Ley 1751, por medio de la cual se regula el derecho fundamental a la salud y se dictan otras disposiciones (2015 feb. 16).
Colombia, Ministerio de Salud y Protección Social. Resolución 330, por la cual se adopta el procedimiento técnico-científico y participativo para la determinación de los servicios y tecnologías que no podrán ser financiados con recursos públicos asignados a la salud y se establecen otras disposiciones (2017, feb. 14).
Vélez M, Wilson MG, Abelson J, et al. Understanding the role of values in health policy decision-making from the perspective of policy-makers and stakeholders: A multiple-case embedded study in Chile and Colombia. Int J Heal Policy Manag. 2019;9(5):185-97. DOI: https://doi.org/10.15171/ijhpm.2019.94
Vélez CM, Wilson MG, Lavis JN, et al. A framework for explai-ning the role of values in health policy decision-making in Latin America: A critical interpretive synthesis. Heal Res Policy Syst. 2020;18:1-17. DOI: https://doi.org/10.1186/s12961-020-00584-y
Pantoja T, Barreto J, Panisset U. Improving public health and health systems through evidence informedpolicy in the Americas. BMJ. 2018;362:k2469. DOI: https://doi.org/10.1136/bmj.k2469
Carman KL, Maurer M, Mangrum R, et al. Understanding an in-formed public’s views on the role of evidence in making health care decisions. Health Aff. 2016;35(4):566-74. DOI: https://doi.org/10.1377/hlthaff.2015.1112
World Health Organization. Evidence, policy, impact: WHO gui-de for evidence-informed decision-making. Geneva, Switzer-land: World Health Organization [internet]; 2021 [citado 2024 abr. 24]. Disponible en: https://www.who.int/publications/i/item/9789240039872
Global Commission on Evidence to Address Societal Challenges. Global Evidence Commission update 2024: Building momentum in strengthening domestic evidence-support systems, enhancing the global evidence architecture, and putting evidence at the cen-tre of everyday life. Hamilton, Ontario: McMaster University [in-ternet]; 2024 [citado 2024 abr. 24]. Disponible en: https://www.mcmasterforum.org/docs/default-source/evidence-commission/update-2024.pdf
Yin RJ. Chapter 2: Designing case study- identifying your case(s) and establishing the logic of your case: What Are the potential single-case designs (Types 1 and 2)? En: Case study research: De-sign and methods. 6th ed. Thousand Oaks, CA SAGE Publications Inc.; 2017. pp. 87-90.
Patiño-Lugo DF, Vélez CM, Díaz-Hernández DP, et al. Whoever wants better healthcare simply pays more: Citizens’ perception about voluntary private health insurance in Colombia. Int J Equity Health. 2024;23:1-10. DOI: https://doi.org/10.1186/s12939-023-02086-z
Charmaz K. Constructing grounded theory. 2nd ed. Los Angeles: SAGE Publications Inc.; 2014.
Londoño-F JL, Nieto-L E. Factores socioeconómicos y asegu-ramiento en salud en el área urbana de Colombia. Rev Fac Nac Salud Pública [internet]. 2000 [citado 2024 abr. 24]; 19(1):25-40. Disponible en: https://revistas.udea.edu.co/index.php/fnsp/article/view/902
Rosoff PM. Drawing the line: Healthcare rationing and the cutoff problem. Oxford: Oxford University Press; 2017. DOI: https://doi.org/10.1093/acprof:oso/9780190206567.001.0001
Docherty M, Garner S, et al. Using evidence to stop ineffective practice: The UK Cochrane Centre (UKCC) and the National Institute of Health and Clinical Excellence (NICE) work to-gether. Cochrane Database Syst Rev [internet]. 2011 [citado 2024 abr. 24]; (Supl. 233):258. Disponible en: https://abstracts.cochra-ne.org/2011-madrid/using-evidence-stop-ineffective-practice-uk-cochrane-centre-ukcc-and-national-institute?
Davies B. Medical need and health need. Clin Ethics. 2023;18(3):287-91. DOI: https://doi.org/10.1177/14777509231173561
Roosma F, van Oorschot W, Gelissen J. The weakest link in welfare state legitimacy: European perceptions of mo-ral and administrative failure in the targeting of social bene-fits. Int J Comp Sociol. 2014;55(6):489-508. DOI: https://doi.org/10.1177/0020715214565932
Jacques O, Noël A. Targeting within universalism. J Eur Soc Policy. 2021;31(1):15-29. DOI: https://doi.org/10.1177/0958928720918973
Caminada K, Goudswaard K, Wang C, Wang J. Income Inequality and Fiscal Redistribution in 31 Countries After the Crisis. Comp Econ Stud 2019;61:119-48. DOI: https://doi.org/10.1057/s41294-018-0079-z
Benavides FG, Delclós J, Serra C. Estado del bienestar y sa-lud pública, una relación que debe ser actualizada. Gac Sa-nit. 2018;32(2):193-7. DOI: https://doi.org/10.1016/j.gace-ta.2017.07.006
Vogt F, Armstrong D, Marteau TM. General practitioners’ percep-tions of the effectiveness of medical interventions: An explora-tion of underlying constructs. Implement Sci. 2010;5:1-8. DOI: https://doi.org/10.1186/1748-5908-5-17
Eger J, Schneider SH, et al. Does Evidence Matter? The Impact of Evidence Regarding Aid Effectiveness on Attitudes Towards Aid. Eur J Dev Res. 2023;35:1149-72. DOI: https://doi.org/10.1057/s41287-022-00570-w
Daniels N. Accountability for reasonableness: Establishing a fair process for priority setting is easier than agreeing on principles. BMJ Br Med J. 2000;321:1300. DOI: https://doi.org/10.1136/BMJ.321.7272.1300
Ramos JGR, Forte DN. Accountability for reasonableness and cri-teria for admission, triage and discharge in intensive care units: An analysis of current ethical recommendations. Rev Bras Ter Intensiva [internet]. 2021 [citado 2024 abr. 24]; 33(1):38-47. Dis-ponible en: https://www.scielo.br/j/rbti/a/py3b3NWvFgNj6QtvVFT9t3w/?lang=en
Urrutia J. Un Proceso Justo Para Asignar Prioridades En Salud: Teoría Y Práctica. En: Informe final Conferencia Taller Ética en la priorización en salud pública y en la priorización en salud [in-ternet]. 2015 [citado 2024 may. 21]; 14-17. Disponible en: https://repositorio.uniandes.edu.co/server/api/core/bitstreams/b10887a3-eb1f-4acf-ad7c-db3ef0c4ec0c/content
Downloads
Published
How to Cite
License
Copyright (c) 2024 Universidad de Antioquia
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The contents of the articles are the responsibility of the authors
The editorial committee has editorial independence from the National School of Public Health "Héctor Abad Gómez" of the University of Antioquia.
The editorial committee is not responsible for aspects related to copying, plagiarism or fraud that may appear in the articles published in it.
When you are going to reproduce and disclose photographs or personal data in printed or digital format, informed consent is required. Therefore, this requirement is required of the author at the time of receipt of the manuscript.
Authors are responsible for obtaining the necessary permissions to reproduce any material protected by reproduction rights.
The authors preserve the moral rights and assign the economic rights that will correspond to the University of Antioquia, to publish it, distribute electronic copies, include them in indexing services, directories or national and international databases in Open Access, under the Creative Commons Attribution license -Not Commercial-Share Equal 4.0 International Commercial (CC BY-NC-SA) which allows others to distribute, remix, retouch, and create from the work in a non-commercial way, as long as the respective credit and license are granted. new creations under the same conditions.
The authors will sign the declaration of transfer of economic rights to the University of Antioquia, after the acceptance of the manuscript.
The editorial committee reserves the right to reject the articles whose authors do not offer satisfactory explanations about the contribution of each author, to meet the criteria of authorship in the submission letter. All authors must meet the four criteria of authorship according to ICMJE: "a) .- That there is a substantial contribution to the conception or design of the article or to the acquisition, analysis or interpretation of the data. b) That they have participated in the design of the research work or in the critical review of its intellectual content. c) .- That has been intervened in the approval of the final version that will be published.d). That they have the capacity to respond to all aspects of the article in order to ensure that issues related to the accuracy or integrity of any part of the work are adequately investigated and resolved. "
-- 
--
