Marta Beatriz Gaviria

Bio: Marta Beatriz Gaviria is an academic researcher from University of Antioquia. The author has contributed to research in topics: Public health & Health informatics. The author has an hindex of 2, co-authored 2 publications receiving 71 citations.

Tuberculosis control and managed competition in Colombia.

Abstract: Law 100 introduced the Health Sector Reform in Colombia, a model of managed competition. This article addresses the effects of this model in terms of output and outcomes of TB control. Trends in main TB control indicators were analysed using secondary data sources, and 25 interviews were done with key informants from public and private insurers and provider institutions, and from the health directorate level. We found a deterioration in the performance of TB control: a decreasing number of BCG vaccine doses applied, a reduction in case finding and contacts identification, low cure rates and an increasing loss of follow up, which mainly affects poor people. Fragmentation occurred as the atomization and discontinuity of the technical processes took place, there was a lack of coordination, as well as a breakdown between individual and collective interventions, and the health information system began to disintegrate. The introduction of the Managed Competition (MC) in Colombia appeared to have adverse effects on TB control due to the dominance of the economic rationality in the health system and the weak state stewardship. Our recommendations are to restructure the reform's public health component, strengthen the technical capacity in public health of the state, mainly at the local and departmental levels, and to improve the health information system by reorienting its objectives to public health goals. Copyright © 2004 John Wiley & Sons, Ltd.

Papel del personal de salud en el diagnóstico tardío de la tuberculosis pulmonar en adultos de Medellín, Colombia

Abstract: OBJETIVO: Describir el papel que desempena el personal de salud (PS) en el retraso del diagnostico de la tuberculosis pulmonar (TBP) en la poblacion adulta de una ciudad colombiana. METODOS: Estudio de caso sobre el diagnostico de la TBP en adultos de la ciudad de Medellin, Colombia, en 2007. Se recogieron datos cuantitativos y cualitativos mediante entrevistas en profundidad a 19 pacientes (11 con diagnostico oportuno y 8 con diagnostico tardio), la revision de sus historias clinicas y encuestas sobre los conocimientos y las practicas relacionadas con la TBP a 89 medicos y enfermeros de 12 instituciones prestadoras de servicios de salud. Se realizo un taller investigativo con los pacientes a fin de socializar los resultados y validar las categorias emergentes. RESULTADOS: Se observo un escaso conocimiento sobre la TBP y una imagen estereotipada de los pacientes que llevan a malinterpretar los sintomas y emplear tratamientos sintomaticos. Los insuficientes conocimientos del PS sobre los factores de riesgo y el cuadro clinico dificultaron el diagnostico cuando el paciente no reflejaba el estereotipo o presentaba una enfermedad ya conocida. La desinformacion sobre la transmision de la TBP y la prescripcion incorrecta de medidas de aislamiento propiciaron practicas discriminatorias y aislamiento social y reforzaron los estereotipos y la estigmatizacion, lo que tambien limito la busqueda de ayuda medica. CONCLUSIONES: El PS desempeno un papel fundamental en el diagnostico tardio de la TBP en los adultos estudiados. Las creencias asociadas con el estigma social y el insuficiente conocimiento sobre la enfermedad -compartidos por el PS y los pacientes- contribuyen a la construccion social del estereotipo de la enfermedad y el enfermo y reducen las posibilidades de llegar a un diagnostico oportuno de la TBP.

Challenging inequity through health systems

Abstract: Published version of the final report of the Health Systems Knowledge Network submitted to WHO in June 2007.

Reforming China's Rural Health System

Abstract: This book began in 2003 during the initial formulations of China's 11th five-year plan, which covers the period 2006-10. During the entire period, the rural health Analytic and Advisory Activities (AAA) team analyzed the sector and debated reform options with government officials and scholars. It is helped the government in its extensive reform efforts over the past few years. The publication can serve two important functions: to provide an analytical framework for thinking about what happened in China's rural health system and why, and to present a global perspective on the options for further strengthening the sector. China is well on its way to achieving a modern, equitable, and well-functioning rural health sector, but this is not an easy task for any country. This book can provide a useful reference for policy makers in the next phase of health reform and beyond.

Health System Reform in Mexico: A Critical Review

Abstract: Last year Lancet published a series of articles on Mexico's 2004 health system reform. This article reviews the reform and its presentation in the Lancet series. The author sees the 2004 reform as a continuation of those initiated in 1995 at the largest public social security institute and in 1996 at the Ministry of Health, following the same conceptual design: "managed competition". The cornerstone of the 2004 reform-the voluntary Popular Health Insurance (PHI)--will not resolve the problems of the public health care system. The author assesses the robustness and validity of the evidence on which the 2004 reform is based, noting some inconsistencies and methodological errors in the data analysis and in the construction of the "effective coverage" index. Finally, some predictions about the future of PHI are outlined, given its intrinsic weaknesses. The next two or three years are critical for the viability of PHI: both families and states will face increasing difficulties in paying the insurance premium; health infrastructure and staff are insufficient to guarantee the health package services; and the private service contracting will further strain state health ministries' ability to strengthen service supply. Moreover, redistribution of federal health expenditure favoring PHI at the cost of the Social Security Institute will further endanger public health care delivery.

Social health insurance vs. tax-financed health systems - evidence from the OECD

Abstract: This paper exploits the transitions between tax-financed health care and social health insurance in the OECD countries over the period 1960-2006 to assess the effects of adopting social health insurance over tax finance on per capita health spending, amenable mortality, and labor market outcomes. The paper uses regression-based generalizations of difference-in-differences and instrumental variables to address the possible endogeneity of a country's health system. It finds that adopting social health insurance in preference to tax financing increases per capita health spending by 3-4 percent, reduces the formal sector share of employment by 8-10 percent, and reduces total employment by as much as 6 percent. For the most part, social health insurance adoption has no significant impact on amenable mortality, but for one cause-breast cancer among women-social health insurance systems perform significantly worse, with 5-6 percent more potential years of life lost.