Portal de Periódicos da CAPES

Colombia's health reform: false debates, real imperatives

2010; Elsevier BV; Volume: 375; Issue: 9717 Linguagem: Inglês

10.1016/s0140-6736(10)60341-8

1474-547X

Esteban Londoño, R Dario-Gómez, P De Vos,

Primary Care and Health Outcomes

Thomas Tsai's World Report1Tsai TC Second chance for health reform in Colombia.Lancet. 2010; 375: 109-110Summary Full Text Full Text PDF PubMed Scopus (19) Google Scholar illustrates some fundamental contradictions in Colombia's health-care system. First, the discrepancy between health insurance coverage and health care coverage. While the government claims an impressive extension of health insurance coverage, hundreds of thousands of law suits—known as tutelas—are brought to the Constitutional Court by citizens in search of necessary health interventions denied by their private insurers. These denials impose suffering, medical complications, disability, and death to the insurance company's affiliates.2Abadía CE Oviedo DG Bureaucratic itineraries in Colombia: a theoretical and methodological tool to assess managed-care health care systems.Soc Sci Med. 2009; 68: 1153-1160Crossref PubMed Scopus (92) Google Scholar Second, although the high cost of these interventions is invoked as the reason for denial, the artificial inflation of administrative and intermediation costs, absorbing 25–30% of the health system's resources, permits health insurance companies to expand exponentially.3Baron-Leguizamon G Gasto Nacional en Salud de Colombia, 1993–2003: composición y tendencias.Rev Salud Publica. 2007; 9: 167-179Crossref PubMed Google Scholar Today, some of them are classified as among the most important businesses in the country. Third, because the T-760 ruling of the Constitutional Court obliged the government to guarantee the right to health care for all Colombians, the private insurers' shortcomings in their health-care obligations are now paid for by the governmental Solidarity and Guarantee Fund (Fosyga). This situation has led to sharp increases in public expenditure. A recent government decree declared a “social emergency” because of this health financing crisis.4Ministerio de la Protección SocialDecree 4975.http://www.minproteccionsocial.gov.co/VBeContent/library/documents/DocNewsNo19174DocumentNo11427.PDFGoogle Scholar Instead of putting limits on the lucrative health insurance business, new taxes will now be raised and co-payments for the poorest will be increased to pay off the US$450 million that Fosyga owes to the private insurance companies.5Cardona A ¿Para qué una emergencia social? Revista Semana.http://www.semana.com/noticias-salud–seguridad-social/para-emergencia-social/133048.aspxDate: Dec 23, 2009Google Scholar While more public money is channelled to the private sector, structural flaws remain untouched. We declare that we have no conflicts of interest.