La última reforma del sistema general de seguridad social en salud Colombiano
01 Sep 2012-Vol. 14, Iss: 5, pp 865-877
TL;DR: The challenges and opportunities arising from reforming Colombian law 1438/2011 dealing with the healthcare-related social security system were explored and the crucial points necessary for major structural reform of the Colombian healthcare system based on the right to health and equity were outlined.
Abstract: Objective This essay was aimed at exploring and analysing the challenges and opportunities arising from reforming Colombian law 1438/2011 dealing with the healthcare-related social security system. Methods Some outstanding issues from the reform introduced by Law 100/1993 were reviewed and then compared to the 2011 regulations; they were also contrasted (in market model conditions) with some public health strategies which were inoperative during the reform stage. Results This second reform phase was discussed in relation to the scope of the right to health, access and overall equity. Progress regarding important issues such as benefit package equalisation, primary healthcare attention, integrated healthcare service networks was recognised; however, its failure to change core aspects of the system was discussed, i.e. financial sustainability and the economic rationale imposed on the aforementioned strategies which curtailed its responsiveness to keep the model introduced by law 100/1993 intact. Conclusion The crucial points necessary for major structural reform of the Colombian healthcare system based on the right to health and equity were then outlined.
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TL;DR: An intervention was carried out in eight communities in Bogota and Cundinamarca to build community capacity to influence health and enabled development of initiatives for solving various problems by different types of organizations.
Abstract: Primary health care looks beyond clinical services to health promotion and primary prevention at the population level. In 2011, Colombia adopted a normative approach to primary health care, to advance efforts to set health priorities and transcend a curative, hospital-based system. An intervention was carried out in eight communities in Bogota and Cundinamarca, Colombia to build community capacity to influence health. Activities included training community leaders to design and implement health improvement initiatives aimed at the most important health problems identified by their organizations. Twenty-eight leaders completed the training. They designed and implemented eight health improvement plans to address the most important health problems in their respective communities: protecting public spaces for children’s physical activities, improving family practices in child nutrition, organizing a health insurance beneficiaries’ health promotion network, organizing a service delivery network for homeless persons, connecting people with cognitive disabilities to treatment services, combatting violence against women, working against child abuse, and integrating health education into school curricula. Lessons were learned about capacity-building in primary care, approaches to strengthening intra- and interinstitutional conditions, and managing processes for community ownership. The intervention enabled development of initiatives for solving various problems by different types of organizations, highlighted participants’ understanding of their role as health agents, and promoted community participation and intersectoral action.
36 citations
30 May 2014
TL;DR: In this paper, the authors examine the processes and outcomes of welfare regimes reforms in eleven Latin American countries, between 1980 and 2010, by comparing pensions, health care, and social assistance policies.
Abstract: This dissertation examines the processes and outcomes of welfare regimes reforms in eleven Latin American countries, between 1980 and 2010. It theorizes the reforms by comparing pensions, health care, and social assistance policies. In so doing, it confronts three theoretical goals. First, it provides an explanation of recent transformations of welfare regimes as resulting from the combined effects of gradual institutional change and exogenous socioeconomic transformations. Second, it explores the potentialities and limitations of historical institutionalism. Third, it identifies emerging patterns of governance.
Mismatches between institutions and social problems trigger reforms, but do not determine the options that policy makers finally choose. Frictions caused by emerging social risks interact with difficulties of established welfare regimes to cope with old risks to facilitate access to public agendas for reformist projects. Ultimately, however, reforms depend on the construction of pro-and anti-reform coalitions, shaped by two main forces: 1) lines of discrimination in the distribution of benefits by existing welfare regimes; 2) strategies of parties, interest groups, and bureaucracies, competing to activate those cleavages according to their interests.
Socioeconomic change, fiscal strain, and transnational factors, interact to make the expansion of social protection contingent upon redistributions of burdens and benefits guaranteed to trigger resistance from groups privileged by existing schemes. The strategic challenge for reformist politicians is the crafting of formulas aimed at simultaneously neutralizing potential veto coalitions and mobilizing unprotected populations. This requires combining strategies of blame-avoidance and credit-claiming that variably mix persuasion, exclusion, and division targeting potential opposition. Selective pay-offs to appease privileged groups constitute the most direct determinants of the architecture of reforms.
In explaining the reforms, I discuss endogenous institutional change and how this results in fragmented social protection policies. However, exogenous shocks may facilitate changes away from expected paths. Certain institutional configurations are also found to block the consolidation of structural reforms entailing drastic institutional discontinuity, leading to situations of chronic instability and serial institutional replacement.
32 citations
01 Jun 2012
TL;DR: There needs to continue the ideological debate on structural reform of the health system and continue with technical developments, instrumental and implement strategies for integrated networks of health services and primary health care, to strengthen integrated health systems.
Abstract: Resumen es: El proposito de la revision tematica fue definir unos ejes tematicos para interpretar la reforma en salud y orientar un nuevo modelo del sistema. El meto...
16 citations
TL;DR: A critical review of the role of health professionals in primary health care expands the functions of the healthcare professional in this field and the general practitioner, in particular, as well as their actions and training.
Abstract: Objective: this paper presents a critical review of the role of health professionals in primary health care. Methodology: narrative review concepts of primary health care, their connections with different models of health, the role of the health team in both the Primary Health Care and its various approaches. The revision expands the functions of the healthcare professional in this field and the general practitioner, in particular, as well as their actions and training. O p i n i o n
15 citations
TL;DR: The results suggest that the 1993 reform conceived of health as a public service to be provided by the market, and the Colombian case underscores the limits of structuring health systems with heavy market participation.
Abstract: Resumo: O sistema de saude da Colombia representa um caso ilustrativo das reformas neoliberais na America Latina, caracterizado pela ampla participacao do setor privado na administracao dos recursos e na prestacao de servicos de saude. O sistema compreende um regime de beneficios para as pessoas com capacidade de pagamento e um pacote de servicos basicos com financiamento estatal para as pessoas pobres. A pesquisa teve por objetivo analisar os arranjos publico-privados no sistema de saude da Colombia entre 1991 e 2015, abarcando as dimensoes de asseguramento e financiamento. Realizou-se um estudo de caso que compreendeu revisao bibliografica, analise documental e de dados secundarios. Os resultados sugerem que a reforma de 1993 concebeu a saude como um servico publico a ser provido pelos mercados. Houve mudancas no papel do Estado, que delegou funcoes da atencao a saude ao setor privado mediante acoes regulatorias e contratuais. A partir de 2000, reformas incrementais compreenderam mudancas instrumentais no sistema, e outras iniciativas buscaram expandir as responsabilidades do Estado na garantia do direito a saude. Em termos de asseguramento, os principais avancos foram a expansao da cobertura do seguro e a igualacao das cestas de beneficios entre regimes (ainda que tardios). Quanto ao financiamento, destacam-se as inequidades no gasto per capita entre regimes e a ineficiencia da intermediacao financeira. O caso colombiano evidencia limites na estruturacao de sistemas de saude com forte participacao de mercados, contribuindo para a reflexao sobre os desafios da protecao social em saude nos paises da America Latina.
12 citations
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01 Aug 1994
TL;DR: This work analyzes the complicated processes involved in the formulation of health policies and offers practical examples and explanatory text for health workers, managers and academics.
Abstract: This work, featuring practical examples and explanatory text, analyzes the complicated processes involved in the formulation of health policies. It is intended for health workers, managers and academics.
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TL;DR: The primary prevention of rheumatic diseases is one book that the authors really recommend you to read, to get more solutions in solving this problem.
Abstract: A solution to get the problem off, have you found it? Really? What kind of solution do you resolve the problem? From what sources? Well, there are so many questions that we utter every day. No matter how you will get the solution, it will mean better. You can take the reference from some books. And the the primary prevention of rheumatic diseases is one book that we really recommend you to read, to get more solutions in solving this problem.
243 citations
TL;DR: This essay proposes a review of the issues of equity and reform in Latin America and the Caribbean in the context of changes in recent decades, emphasizing the discussion of health systems reform.
Abstract: This essay proposes a review of the issues of equity and reform in Latin America and the Caribbean in the context of changes in recent decades, emphasizing the discussion of health systems reform. The economic, political, and social context prevailing in the critical 1970s extensively favored budget cuts for public expenditures, cost containment, changes in the health sector power structure, and health services reorganization from an 'economicist', pragmatic, and restrictive perspective. An inventory of the Latin American economic and social situation is markedly negative, and efforts to recover from the damage done in the 1980s were largely unsuccessful in the 1990s. The reforms implemented in some paradigmatic countries (Chile, Colombia, Costa Rica, Argentina, and Brazil), in light of their specific characteristics, demonstrate the dissemination of a common agenda, adapted to the various national conditions. Some positive results of these processes were diluted in new problems caused by the reforms themselves, especially in countries with more radical adherence to the new reformist model; meanwhile, in the country where the public, universal system based on solidarity was most consolidated, the management changes have obtained the best results. However, overcoming inequalities is still a distant goal.
94 citations
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TL;DR: Organized delivery systems will be the vehicle for addressing cost, technology, quality, Chronic illness, chronic illness, and information management issues in the context of caring for defined populations.
Abstract: Organized delivery systems will be the vehicle for addressing cost, technology, quality, chronic illness, and information management issues in the context of caring for defined populations.
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