Costs of denied health care services and of the lawsuits filed to obtain them in Medellín, 2009
DOI:
https://doi.org/10.17533/udea.rfnsp.8733Keywords:
writ for the protection of constitutional rights, right to health, health costs, transaction costs, Act 100 of 1993Abstract
Objective: to retrace the legal route of writs for the protection of constitutional rights involving health care services and to determine the cost of such processes and those of the health care services invoked in a sample of such writs taken in Medellín city. Methods: a descriptive study with a qualitative focus for retracing the legal route of the writs, and a quantitative approach for the purpose of cost estimation. The 2009 SOAT (Mandatory Car Insurance) fees were used for assessing the cost of the health care services. As for the assessment of the legal costs, we used the micro-costing approach together with the activity-based costing methodology. Results: for each $100 corresponding to the cost of the services denied by the health care services provider, the Medellín judicial system spent around $48 on each legal process. In more tan half of the cases, the cost of the legal action was higher than the services’ cost. Discussion: the cost of the legal process involving the writs for the protection of constitutional rights regarding health care services that were filed in the country between 1999 and 2009 could represent 2% of the budget circulating throughout the entire health system. This cost is just a part of the transaction costs generated by the health care services providers’ breach of the social contract established by the Colombian Constitution. Furthermore, in most cases there is also a breach of the private contract between these service providers and the health system users.
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(1). Hernández M. Neoliberalismo en salud: desarrollos, supuestos y alternativas. En: Restrepo DI., ed. La falacia neoliberal. Crítica y alternativas. Bogotá: Vicerrectoría Académica y Sede Bogotá, Universidad Nacional de Colombia; 2003. p. 347-361.
(2). Organización Panamericana de la Salud, Oficina Sanitaria Panamericana, Oficina Regional de la Organización Mundial de la Salud. El financiamiento de los servicios de salud en los países en desarrollo: una agenda para la reforma. En: Economía de la salud: Perspectivas para América Latina. Washington: ops; 1989.
(3). Banco Mundial. Invertir en salud. Informe del desarrollo mundial. Washington: bm; 1993.
(4). Enthoven A. Thery and practice of Managed Competition in Health Care Finance. Amsterdam: North Holland; 1988. DOI: https://doi.org/10.1016/B978-0-444-70359-0.50008-0
(5). Frenk J, Londoño JL. Pluralismo estructurado: hacia un modelo innovador para las reformas de los sistemas de salud en América Latina. Rev. Salud y Gerencia 1997; 15(1). DOI: https://doi.org/10.18235/0012013
(6). Mushkin S. Toward a Definition of Health Eeonomies. [Inter-net] [acceso 13 de febrero de 2011] Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1951624/pdf/pubhealthre-porig00021-0025.pdf
(7). Arrow K. Uncertainty and the Welfare Economics of Medical Care. American Economic Review 1963; 53: 941-973.
(8). Nieto E. Avances en economía de la salud y su incidencia en la reforma sectorial. Facultad Nacional de Salud Pública. Cartilla de seguridad social No 4, 1998.
(9). Restrepo J, Echeverri E, Vásquez J, Rodriguez S. El seguro subsidiado y el acceso a los servicios de salud. Teoría, contexto colom-biano y experiencia en Antioquia. Medellín: Centro de Investiga-ciones Económicas, Universidad de Antioquia; 2006.
(10). Departamento Administrativo Nacional de Estadística. Encuesta de Calidad de Vida 2003. Bogotá: dane; 2004.
(11). Facultad Nacional de salud Pública. Pronunciamientos de la Facultad Nacional de Salud Pública frente a la declaratoria de Emergencia Social. Iniciativas por la salud pública. Medellín: Rev. Fac. Nac. Salud Pública; 2010.
(12). El Congreso de la República de Colombia. Constitución Política de Colombia. Bogotá: El Congreso; 1991.
(13). Corte Constitucional de la República de Colombia. Sentencia T-760. Bogotá: La Corte; 2008.
(14). Defensoría del Pueblo de la República de Colombia. La tutela y el derecho a la salud 2009. Bogotá: La Defensoría; 2010.
(15). Rodríguez C. Vulneración del derecho a la salud expresado en las solicitudes y acciones de tutela tramitadas en el municipio de Medellín, 2001–2007. [Trabajo de grado Maestría en Salud Pública]. Medellín: Universidad de Antioquia. Facultad Nacional de Salud Pública; 2008.
(16). Yepes F, Ramírez M, Sánchez LH, Ramírez ML, Jaramillo I. Luces y sombras de la reforma de la salud en Colombia: Ley 100 de 1993. Bogotá: idrc; 2010.
(17). Grupo Economía de la Salud. Oferta del seguro público de salud en Colombia. Observatorio de la seguridad social. Medellín: Universidad de Antioquia; 2001.
(18). Gorbaneff Y, Torres S, Contreras N. Fuentes de poder de las aseguradoras frente a las prestadoras hospitalarias en el sistema de salud colombiano. Rev. Gerencia y políticas de salud 2008; 7(14): 177-186.
(19). Abadía C, Oviedo D. Bureaucratic itineraries in Colombia. A theoretical and methodological tool to assess manager-care health care system. Scial Science & Medicine 2009; 68. DOI: https://doi.org/10.1016/j.socscimed.2008.12.049
(20). Molina G, Vargas J, Berrío A, Muñoz DP. Características de la contratación entre aseguradores y prestadores de servicios de salud, Medellín 2007-2008. Rev. Gerencia y políticas de salud 2010; 9(18): 103-115.
(21). Torres S, García RG, Quintero JJ. Costos de transacción y formas de gobernación de los servicios de consulta en Colombia. Rev. Cuadernos de economía 2007; 44(1): 233-262.
(22). Gorbaneff Y, Torres S, Contreras N. Anatomía de la cadena de prestación de salud en Colombia. Rev. Innovar 2004; 23: 168-181.
(23). Jaramillo I. Análisis comparativo de los costos de transacción, administración o intermediación de los sistemas de salud en algunos países de América Latina y de la ocde. Washington: bid; 2007.
(24). Marcelo G. El Costo Basado en Actividades: un enfoque desde su Aplicación Práctica en Empresas Argentinas. Buenos Aires: Pod-moguilnye; 2004.
(25). Somarraba J. Introducción a la contabilidad de costos. Barranquilla: Universidad nacional de ingeniería Uninorte; 2008.
(26). Drummond M, O’Brien B.J, Stoddart G.L. Métodos para la evaluación económica de los programas de asistencia sanitaria. Ma-drid: Ediciones Díaz de Santos; 2001.
(27). Unión Europea. Informe de la comisión de investigación sectorial sobre el sector farmacéutico, septiembre de 2009. [Internet] [ac-ceso 28 julio de 2010]. Disponible en: http://ec.europa.eu/compe-tition/sectors/pharmaceuticals/inquiry/communication_es.pdf
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