International financial institutions have played an increasing role in the formation of social policy in Latin American countries over the last two decades, particularly in health and pension programs. World Bank loans and theirattachedpolicyconditionshavepromotedseveralsocialsecurityreforms within a neoliberal framework that privileges the role of the market in the provision of health and pensions. Moreover, by endorsing the privatization of health services in Latin America, the World Health Organization has converged with these policies. The privatization of social security has benefited international corporations that become partners with local business elites. Thus the World Health Organization, international financial institutions, and transnational corporations have converged in the neoliberal reforms of social security in Latin America. Overall, the process represents a mechanism of resource transfer from labor to capital and sheds light on one of the ways in which neoliberalism may affect the health of Latin American populations. Most Latin American countries have implemented extensive reforms of their welfare states, reforms characterized by a shift, from the public to the private sector, in the delivery and financing of health and other social security services such as old age and disability pensions and workers’ compensation. The arguments for the effectiveness of such changes follow the neoliberal paradigm that assigns to the private market the ability to best allocate and use resources, even in the field of public health. The purpose of this analysis is to investigate the role of international financial institutions (IFIs)—the Word Bank, International

http://www.med-informatica.net/OBSERVAMED/ReformaSistemaSalud/EmergenciaSocial2010/Privatizacion%20latin%20america%20WB%20FMI%20WHO%20Important.pdf

Neoliberalism and Health and Social Policy HEALTH AND SOCIAL SECURITY REFORMS IN LATIN AMERICA: THE CONVERGENCE OF THE WORLD HEALTH ORGANIZATION, THE WORLD BANK, AND TRANSNATIONAL CORPORATIONS

The health sector reform in Colombia, initiated by Law 100 (1993) that introduced a managed competition model, is generally presented as a successful experience of improving access to care through a health insurance regulated market. The study's objective is to improve our understanding of the factors influencing access to the continuum of care in the Colombian managed competition model, from the social actors' point of view. An exploratory, descriptive-interpretative qualitative study was carried out, based on case studies of four healthcare networks in rural and urban areas. Individual semi-structured interviews were conducted to a three stage theoretical sample: I) cases, II) providers and III) informants: insured and uninsured users (35), health professionals (51), administrative personnel (20), and providers' (18) and insurers' (10) managers. Narrative content analysis was conducted; segmented by cases, informant's groups and themes. Access, particularly to secondary care, is perceived as complex due to four groups of obstacles with synergetic effects: segmented insurance design with insufficient services covered; insurers' managed care and purchasing mechanisms; providers' networks structural and organizational limitations; and, poor living conditions. Insurers' and providers' values based on economic profit permeate all factors. Variations became apparent between the two geographical areas and insurance schemes. In the urban areas barriers related to market functioning predominate, whereas in the rural areas structural deficiencies in health services are linked to insufficient public funding. While financial obstacles are dominant in the subsidized regime, in the contributory scheme supply shortage prevails, related to insufficient private investment. The results show how in the Colombian healthcare system structural and organizational barriers to care access, that are common in developing countries, are widened by both the insurers' use of mechanisms that limit the utilization and the public healthcare providers' change of behavior in a competition environment. They provide evidence to question the promotion of the managed competition model in low and middle-income countries.

https://link.springer.com/content/pdf/10.1186%2F1472-6963-10-297.pdf

Barriers of access to care in a managed competition model: lessons from Colombia.

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 a...

Colombia: in vivo test of health sector privatization in the developing world.

Universal health care for Colombians 10 years after Law 100: challenges and opportunities.

Inequities in cervical cancer screening among Colombian women: a multilevel analysis of a nationwide survey.

/pdf/luces-y-sombras-de-la-reforma-de-la-salud-en-colombia-ley-9ld29cc3vo.pdf

Luces y sombras de la reforma de la salud en Colombia. Ley 100 de 1993

/pdf/la-reforma-del-sector-de-la-salud-en-colombia-un-modelo-de-3iracti3re.pdf

Francisco José Yepes Luján

Papers

Luces y sombras de la reforma de la salud en Colombia. Ley 100 de 1993

La reforma del sector de la salud en Colombia: ¿un modelo de competencia regulada?

Editorial:La vacunación contra el virus delPapiloma Humano en Colombia

Ni emergencia, ni salud de la población

El sistema de salud colombiano : grupos relacionados de diagnóstico