DOI•
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.
Citations
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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.
32 citations
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.
22 citations
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.
20 citations
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.
18 citations
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.
17 citations
References
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01 Jan 2001
TL;DR: Evaluating the impact of the transformation of the national health system into the Social Security Health System upon the equity in access to health services as well as their use and quality found problems in equity relate to the design, structure and operation of the model of regulated competition.
Abstract: In the present study we intended to evaluate the impact of the transformation of the national health system into the Social Security Health System upon the equity in access to health services as well as their use and quality. We interpreted equity as the equal opportunity for all people of gaining real access to health services. A cross-sectional study was designed to detect the differences, which might exist between affiliated and non-affiliated people, and the differences in access to and use of health services according to the nature of affiliation. A survey was carried out in 364 households comprising 1324 people aged 9 years or older, in which socio-demographic and labor aspects, affiliation to social security, nature of the affiliation (contributive or subsidized regime), use of health services, attention and expenditure in health services were studied. 297 randomly chosen patients of the outpatient clinics of hospitals of levels 1,2 and 3 were asked to answer a survey about affiliation, awareness of their rights, opportunity and quality of the health service, general satisfaction and social participation. Numerous differences, which could not be justified by necessity, cause for requesting attention, place where people demanded health services, attention received or use of health services, were found once adjustments for gender, age, housing stratum, occupation and income were made. These problems in equity relate to the design, structure and operation of the model of regulated competition.
34 citations
TL;DR: There was an increase in health coverage associated with expansion of the subsidized care system, although a large proportion of the population is still not entitled to health care, and the type of entitlement affects the demand for services.
Abstract: This paper analyzes the main advances in health coverage and health services demand in Colombia using the 1997 and 2003 living standards surveys. The study showed an increase in health coverage associated with expansion of the subsidized care system, although a large proportion of the population is still not entitled to health care. The type of entitlement also directly affects the demand for services. There was an increase in preventive medical consultations in 2003 and a decrease in the use medical care for acute illness, due mainly to lack of money. Access to medicines increased from 1997 to 2003, as reflected by a decrease in out-of-pocket expenditure on medicines.
25 citations
TL;DR: In a recent study, 15 informantes clave, todos personal de salud responsables of the Sistema General de Seguridad Social en Salud (SGSSS) in Colombia, were interviewed.
Abstract: ANTECEDENTES: La reforma en salud en Colombia tuvo un profundo efecto en los programas de salud publica. Los cambios en la estructura organizativa y en las actividades de intervencion en las acciones de control de la tuberculosis (TBC) fue provocado por el surgimiento de nuevos actores en la prestacion de servicios, el diseno de nuevos planes de salud, la diversificacion y ambiguedad de responsabilidades y la descentralizacion del sistema. OBJETIVO: Conocer las percepciones que tienen actores clave del control de la tuberculosis acerca de los efectos generados por la implementacion del Sistema General de Seguridad Social en Salud (SGSSS) de Colombia. MATERIALES Y METODOS: Se presentan los hallazgos cualitativos de un estudio de caso. La tecnica de recoleccion de informacion fue la entrevista semi-estructurada. En total se entrevistaron 15 informantes clave, todos personal de salud responsables de las acciones de control de la tuberculosis en el ambito nacional, departamental y local. RESULTADOS: Los efectos negativos mas relevantes de la implementacion del SGSSS en las acciones de control de la TBC fueron: falta de voluntad politica, corrupcion en el manejo de los recursos, pobre destreza en el desarrollo tecnico-administrativo, deficiencia del Estado en las actividades de supervision a nivel local, inadecuado cumplimiento del Estado en sus obligaciones administrativas y financieras. La diversificacion de las fuentes de financiacion para salud fue descrita como factor facilitante porque incrementa la distribucion de los recursos en las acciones de control. DISCUSION: La reduccion del papel del Estado en las actividades de regulacion y control fue percibido como el principal efecto. La introduccion de nuevos actores en la entrega de servicios de salud y el aumento de la distribucion de los recursos en las acciones de la TBC no dieron los efectos positivos esperados y la cantidad y calidad de las acciones se redujeron.
21 citations
01 Sep 2006
TL;DR: There was differential medical service use amongst the displaced population, determined by their health insurance coverage and economic position, and being from the region were associated with greater service use.
Abstract: Objetivo Analizar los factores y barreras asociadas a la utilizacion de servicios medicos por la poblacion desplazada, como consecuencia del conflicto armado colombiano, residente en Bucaramanga, Colombia. Material y Metodos A partir de datos procedentes del estudio “Diagnostico de Salud de las Poblaciones Desplazadas y no Desplazadas en Bucaramanga y su area Metropolitana” disenado y ejecutado por la Universidad Industrial de Santander y financiado por la Organizacion Panamericana de la Salud, se analizo la utilizacion de los servicios medicos en individuos mayores de 15 anos de edad de acuerdo con el modelo de Andersen y Newman y se evaluo el efecto de los factores asociados mediante regresion logistica multiple. Resultados Una de cada cinco personas que enfermo en los quince dias previos a la encuesta uso los servicios medicos. Este porcentaje es menor a los encontrados en la poblacion general de Colombia. Pertenecer al regimen contributivo de seguridad social, el antecedente de visita a los servicios de salud y ser originario de la misma region se encontraron asociados a la mayor utilizacion de los servicios. Los desplazados que tienen derecho al seguro de salud subsidiado no presentaron diferencias en el uso de los servicios con respecto a los que no cuentan con seguro. La distancia a la institucion de salud fue otra barrera para la utilizacion de servicios (RM=0,64; IC 0,42-0,97). Conclusion Existe un uso de servicios medicos diferencial entre los desplazados, determinado por sus condiciones de aseguramiento y su capacidad economica.
9 citations
01 Jan 2006
TL;DR: In this paper, the factors and barriers associated with the population displaced by armed conflict using medical services in Bucaramanga, Colombia were analyzed and compared with those of the population without armed conflict.
Abstract: Objective Analysing the factors and barriers associated with the population displaced by armed conflict using medical services in Bucaramanga, Colombia. Ma...
9 citations