Luces y sombras de la reforma de la salud en Colombia. Ley 100 de 1993
01 Jul 2010-Vol. 9, Iss: 18, pp 118-123
About: The article was published on 2010-07-01 and is currently open access. It has received 21 citations till now.
TL;DR: Efforts to improve access to cervical cancer screening should focus on disadvantaged women with limited education, low socioeconomic status, and no health insurance or subsidised insurance, especially those in rural/isolated areas.
Abstract: Objectives To identify factors associated with whether women in Colombia have had a Pap test, evaluate differences in risk factors between rural and urban residence, and evaluate the contextual effect of the lack of education on having ever had a Pap test. Method Data used were from the 2010 Colombian National Demographic and Health Survey; 40,392 women reported whether they have had a Pap test. A multilevel mixed logistic regression model was developed with random intercepts to account for clustering by neighbourhood and municipality. The model evaluated whether having a rural/urban area of residence modified the effect of identified risk factors and if the prevalence of no education at the neighbourhood level acted as a contextual effect. Results Most women (87.3%) reported having at least one Pap test. Women from lower socioeconomic quintiles ( p =0.002), who were unemployed ( p p p p =0.03), type of health insurance ( p =0.01), age ( p p p =0.005). Conclusions In Colombia, the probability of having had a Pap test is associated with personal attributes, area of residence, and prevalence of no education in the neighbourhood. Efforts to improve access to cervical cancer screening should focus on disadvantaged women with limited education, low socioeconomic status, and no health insurance or subsidised insurance, especially those in rural/isolated areas.
TL;DR: In this article, an encuesta of acceso a servicios de salud dirigida a hogares in Colombia was presented, with the purpose of disenar and validar a herramienta metodologica of pais that permita ir acumulando evidencia sobre las condiciones de accesos real que tiene la población colombiana.
Abstract: Resumen Objetivo Disenar y validar una encuesta de acceso a servicios de salud dirigida a hogares en Colombia para aportar una herramienta metodologica de pais que permita ir acumulando evidencia sobre las condiciones de acceso real que tiene la poblacion colombiana. Metodo Se realizo un estudio de validacion con personas expertas y prueba piloto aplicada en el municipio de Jamundi, en el departamento del Valle del Cauca, Colombia. Se realizo un muestreo probabilistico, polietapico, estratificado y por conglomerados. La muestra final fue de 215 hogares. Resultados La encuesta quedo conformada por 63 preguntas distribuidas en cinco modulos: perfil sociodemografico del jefe/a del hogar o adulto/a informante, perfil socioeconomico del hogar, acceso a servicios preventivos, acceso a servicios curativos y de rehabilitacion, y gasto de bolsillo en acceso. En terminos descriptivos, la promocion de servicios preventivos solo alcanzo valores del 44%; el uso de estos servicios siempre fue mayor, en especial en los grupos del primer ano de vida y hasta los 10 anos. Para los servicios de urgencias y hospitalizacion, la percepcion de atencion de la necesidad estuvo entre el 82% y el 85%. No obstante, hubo percepcion de mala y muy mala calidad de la atencion hasta en un 36%. Por su parte, la oportunidad de la atencion de consulta medica general y con especialista presento demoras. Discusion La encuesta disenada es valida, relevante y representativa del constructo acceso a servicios de salud en Colombia. En terminos empiricos, la prueba piloto mostro debilidades institucionales en un municipio del pais, indicando ademas que la cobertura en salud no significa acceso real y efectivo a los servicios.
01 Sep 2012
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.
01 Jan 2014
TL;DR: Las mujeres con cancer de mama enfrentan barreras de acceso a los servicios de salud, que estan determinadas socialmente, y frente a las cuales el sistema muestra cierto nivel de incapacidad.
Abstract: Resumen Objetivo: explorar la existencia de barreras de acceso a los servicios de salud en las historias de mujeres con cancer de mama, que han recibido apoyo de seis ong colombianas. Metodologia: se llevo a cabo un estudio cualitativo descriptivo interpretativo, en cinco ciudades colombianas: Bogota, Medellin, Cali, Valledupar y Santa Marta, incluyendo 44 mujeres apoyadas por seis ong . Se realizaron grupos focales y entrevistas en profundidad. Resultados: en el proceso emergieron cuatro categorias: barreras ligadas a los determinantes estructurales, barreras originadas en los determinantes intermedios, herramientas para enfrentar las barreras y una categoria que hace referencia a la oportunidad de obtener un diagnostico y un tratamiento de cancer de mama. A partir de estas categorias, se propone un modelo de barreras de acceso en cancer de mama, desde la perspectiva de los determinantes sociales. Discusion: a pesar de los esfuerzos del pais por mejorar la oportunidad en prevencion, diagnostico y tratamiento del cancer —incluyendo la promulgacion de la ley 1384 de 2010 (Ley Sandra Ceballos)—, las mujeres con cancer de mama enfrentan barreras de acceso a los servicios de salud, que estan determinadas socialmente, y frente a las cuales el sistema muestra cierto nivel de incapacidad.
TL;DR: It is found that difficulties accessing health care services, payments for medical leave, job reassignments, severance packages, and filing for pension benefits were common to all cases and resulted from overwhelming bureaucratic and administrative demands.
Abstract: The impacts of neoliberal or market-based social security reforms in health have been extensively studied. How such reforms transformed employment-related insurance and entitlements, however, has received significantly less attention. This study aims to understand how the employment insurance system operates in Colombia and to assess how the experience of workers seeking social security entitlements relates to the system's structure. We conducted an ethnographic study of the Colombian Occupational Risk System between May 2014 and March 2016, with two main components: 1) analysis of the system itself through in-depth interviews with 32 people working in leadership positions and a systematic review of the system's most important legislation, and 2) a study of people who experienced problems receiving entitlements and were challenging the assessment of their work-related illness or accident. We conducted in-depth interviews with 22 people, followed up with half of them, and reviewed their case files. We found that difficulties accessing health care services, payments for medical leave, job reassignments, severance packages, and filing for pension benefits were common to all cases and resulted from overwhelming bureaucratic and administrative demands. Regional and national evaluation bodies dictate whether a given illness or accident is work-related, and establish a percentage of Loss of Wage Earning Capacity (LWEC). People's disabled bodies rarely reached the threshold of 50% LWEC to qualify for disability pensions. The lengthy process that workers were forced to endure to obtain work-related entitlements always involved the judiciary. The three competing for-profit financial sectors (health insurance, pension funds, and Occupational Risk Administrators) actively challenged workers' demands in order to increase their profits. We conclude that these for-profit sectors work contrary to the principles that sustain social security. Indeed, they push sick and disabled workers to unemployment, informality, economic dependence, and ultimately dire poverty.
01 Jan 2006
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TL;DR: 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.
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.
TL;DR: The consequences of health sector reforms on control of malaria were analyzed using Colombia as an example as mentioned in this paper, where a series of studies was undertaken in 1998-2000 at the national level (Ministry of Health Study), at the state level (Departamento Study) and at the health district level (District Study) using formal and informal interviews among control staff and document analysis as data collection tools.
Abstract: The consequences of health sector reforms on control of malaria were analysed using Colombia as an example. One of the most complex health sector reform programmes in Latin America took place in the 1990s; it included transferring the vertical vector-borne disease control (VBDC) programme into health systems at state and district levels. A series of studies was undertaken in 1998-2000 at the national level (Ministry of Health Study), at the state level (Departamento Study) and at the health district level (District Study) using formal and informal interviews among control staff and document analysis as data collection tools. A government-financed national training programme for VBDC staff - which included direct observation of control operations - was also used to analyse health workers' performance in the postreform period (longitudinal study). The results showed that some shortcomings of the old vertical system, such as the negative aspects of trade union activity, have not been overcome while some positive aspects of the old system, such as capacity building, operational planning and supervision have been lost. This has contributed to a decrease in control activity which, in turn, has been associated with more malaria cases. Malaria control had to be reinvented at a much larger scale than anticipated by the reformers caused by a whole series of problems: complex financing of public health interventions in the new system, massive staff reductions, the difficulty of gaining access to district and state budgets, redefining entire organizations and - in addition to the reforms - introducing alternative strategies based on insecticide-treated materials and the growth of areas of general insecurity in many parts of Colombia itself. However, positive signs in the transformed system include: the strengthening of central control staff (albeit insufficient in numbers) when transferred from the Ministry of Health to the National Institute of Health, the opportunities offered by the Basic Health Plan (PAB) for new planning initiatives and intersectoral co-operation and the integration of malaria diagnosis and treatment into the general health services (associated with a decrease of malaria mortality). The potentials of the new system have not yet been fully exploited: capacity building, communication and management skills need to be improved and it require guidance from the national level.
TL;DR: The general conclusion is that the transition period of health reform in Colombia takes far longer than anticipated and requires a much greater information flow to both the local level and the community.
Abstract: This paper analyzes the effects of health reform in Colombia on public health programs at the local level, particularly the Expanded Program of Immunization (EPI) and the tuberculosis control program. The research was developed in three health districts in two States by analysis of documents, direct observation, and longitudinal follow-up of the transition process. The health districts were unprepared for the change, resulting in insufficient technical skills among staff as well as lack of awareness of important elements in the new system, associated with a reduction in immunization coverage and tuberculosis case detection. Structural problems in the new system included loss of immunization opportunities and lack of examination of tuberculosis contacts. The potentialities of the new system were the local development of a new organizational structure and the improvement of the information system; a limiting factor was exposure of the health system to local political interests. The general conclusion is that the transition period takes far longer than anticipated and requires a much greater information flow to both the local level and the community. There are transitory but also structural maladjustments that require a political response.
TL;DR: Of 11,376 cases, 7,787 were new pulmonary smear-positive cases; most of them were males aged 25 to 34 years, with the highest incidence in age group 65 or older, and a decrease was observed in respiratory symptomatic patients aged 15 years or older.
Abstract: Tuberculosis (TB) remains an important public health problem in Colombia. Therefore, in 2002, the epidemiological behavior of TB was described in order to identify priority interventions for its control. Data were analyzed from the 2002 ?Quarterly Report of Cases and Activities? collected by the National TB Program. TB demonstrated a fluctuating behavior during the past decade, particularly until 1997, when regularly increasing trend began. Two thirds of the 32 departments of Colombia had incidence rates above the national average (>26 per 100,000); six departments were classified as being at very high risk (incidence >50 per 100,000). Of 11,376 cases, 7,787 were new pulmonary smear-positive cases; most of them were males aged 25 to 34 years, with the highest incidence in age group 65 or older. A decrease was observed in respiratory symptomatic patients aged 15 years or older. Smear positivity from all patients was 3.8% and the smear average was 1.6 per patient. Follow up indicators are still under the desirable levels.The application of health care guidelines to TB patients by health care institutions, as well as the development of monitoring activities, the report feedback are essential elements in an effective TB control program. However, successful implementation also requires careful supervision at each level of application and political will at local and department levels to adhere to DOTS.