Health care in Colombia

A psychiatry resident prepares to carry out ECT therapy at the mental health unit of the Federico Lleras Acosta in Ibagué

Health care in Colombia refers to the prevention, treatment, and management of illness and the preservation of mental and physical well being through the services offered by the medical, nursing, and allied health professions in the Republic of Colombia.

Health issues

Tropical diseases are important issues in Colombia, and major causes of death. Malaria affects near 85% of the national territory, mainly the Pacific ocean coast, the Amazon jungle and eastern savannas, with an estimated of 250,000 cases/year and a mortality rate of 3/100,000.^[1] The main agent is Plasmodium vivax with 66% of the cases, except on the Pacific coast, where Plasmodium falciparum causes 75% of the cases.

Yellow fever and Dengue fever^[2] are major public health concerns, due to their high epidemic potential, high mortality rate and wide distribution of Aedes aegypti. The Colombian government develops vaccination campaigns against yellow fever on a regular basis.^[3]

Bothrops atrox is the main cause of death for snakebite in Colombia.

Chagas disease is endemic to the Santander Department and nearby areas. Other diseases such as Leishmania, rabies, Venezuelan equine encephalitis virus and West nile virus are also present in Colombia.^[1] Snakebites are a big concern, because of the shortage in antivenom supplies countrywide.^[4]

Different forms of malnutrition severely affect the population, especially children under five years, with moderate to severe rates of malnutrition of 21% and iron deficiency anemia of 23%.^[5] (see aguapanela).

History

The first graduated medical doctor, Alvaro de Aunón came to New Granada from Sevilla Spain, in 1597 and stayed for a short time. The first drugstore in Colombia was opened at the same time, in the main square of Bogotá by Pedro Lopez Buiza.^[6]

Old map of the New Kingdom of Granada

In 1636, licenciado Rodrigo Enriquez de Andrade started the first medical university in the New Granada, in the St Bartolomé College with little success because of the prejudices against the medical career in the Spanish culture, where it was considered vulgar and proper of lower class people. Most of the medical practice in the country was provided by people without formal education.^[7] The first medical book written in Colombia was "Tratado de medicina y modelo de curar en estas partes de Indias" by Pedro Fernandez de Valenzuela (1662).

In 1740, don Vicente Tomás Cansino started the medical teaching in the Rosario College (Colegio Mayor de Nuestra Señora del Rosario). The medical care at the time was made almost exclusively in the particular homes of the sick people due lo the lack of health institutions. The first hospital in Colombia was the San Pedro Hospital, in the capital city Bogotá. The hospital started its functioning in 1564, built by bishop fray Juan de los Barrios. In 1739 was opened the Hospital San Juan de Dios,^[8] built by fray Pedro Pablo Villamor.

Health standards in Colombia have improved greatly since the 1980s. A 1993 reform transformed the structure of public health-care funding by shifting the burden of subsidy from providers to users. As a result, employees have been obligated to pay into health plans to which employers also contribute. Although this new system has widened population coverage by the social and health security system from 21% (pre-1993) to 56% in 2004 and 66% in 2005, health disparities persist, with the poor continuing to suffer relatively high mortality rates.

The refractive surgery keratomileusis was developed by Ignacio Barraquer in 1964 in Bogotá. On January 10, 1985, Dr. Elkin Lucena performed the fist successful In vitro fertilization, that allowed the birth of the first Latin American test tube baby Carolina Mendez. On December 14, 1985 the Dr. Alberto Villegas performed the first heart transplant in Latin America to Antonio Yepes.^[9]

On May 20, 1994 Dr. Manuel Elkin Patarroyo received the Prince of Asturias Awards by his technical and scientific research in the development of synthetic malaria vaccine.

In 2002 Colombia had 58,761 physicians, 23,950 nurses, and 33,951 dentists; these numbers equated to 1.35 physicians, 0.55 nurses, and 0.78 dentists per 1,000 people, respectively. In 2005 Colombia was reported to have only 1.1 physicians per 1,000 people, as compared with a Latin American average of 1.5.

Status of public health

General government spending on health accounted for 20.5% of total government expenditures and for 84.1% of total health expenditures (private expenditures made up the balance) in 2003. Total expenditures on health constituted 5.6 percent of gross domestic product in 2005. The per capita expenditure on health care in 2005 at an average exchange rate was US$150.^[10]

Urban and rural residents experienced significant differences in access to health care. The coverage in the three largest cities -- Bogotá, Medellín, and Cali -- was almost 95 percent. At the rural level, the best services were delivered by the departments in the coffee-growing areas. At the bottom of the scale -- in terms of quality and coverage -- were the rural areas in the non-Andean regions as well as the marginal neighborhoods in medium-sized and small cities.

Since 2001–2 Colombia has halved its homicide rate, which was more than 60 per 100,000 inhabitants, or 28,837, in 2002, one of the world’s highest homicide rates. In 2006 a total of 17,206 violent deaths were recorded, the lowest figure since 1987. Other than homicide, heart disease is the main cause of premature death, followed by strokes, respiratory diseases, road accidents, and diabetes. Waterborne diseases such as cerebral malaria and leishmaniasis are prevalent in lowland and coastal areas. Child immunization for measles in 2004 as a percentage of children under 12 months of age was 92 percent.^[10]

Acquired immune deficiency syndrome (AIDS) is the fifth-leading cause of death in the working-age population. According to Colombia’s National Health Institute data reported in 2003, nearly 240,000 people — mostly women and young people — or 0.6 percent of the population had been infected with the virus since AIDS arrived in Colombia in October 1983. Estimates of the number of people living with human immunodeficiency virus (HIV), adults and children (0–49 years of age), in 2005 ranged from 160,000 to 310,000. The comparable figure for women (15–49 years of age) was 62,000. The number of AIDS and hepatitis B cases has been rising. In 2005 the estimated HIV adult prevalence rate (15–49 years of age) was 0.6 percent. As of 2006, between 5,200 and 12,000 people had died from AIDS. Services provided by the new Multisectoral National Plan, launched in July 2004, include integrated care for people living with HIV and provision of antiretroviral drugs. Under the plan, about 12,000 people have been receiving combined antiretroviral therapy (approximately 54% of those requiring it).^[10]

Law 100 of 1993

The national constitution was reformed in 1991, and with this purpose the general system of social security was reformed with the implementation of Law 100, that extended widely the health coverage to the population, but the economic resources to finance this reform were insufficient, causing collapse of many public health institutions and affecting the income of the medical staff.^[11] The law 100 of 1993 is divided into four books:

• First book: About Pension regulations.
• Second book: About the general system of healthcare
• Third book: About Occupational safety and health
• Fourth book: About Complementary social services

The reform of the Colombian healthcare had three main goals:

• The achievement of an antitrust policy, to avoid the statal health monopoly.
• The incorporation of private health providers to the healthcare market
• The creation of a subsidiated healthcare sector, covering the poorest population.

The general principles of the law determine that the healthcare is a public service, which must be granted in conditions of proficiency, universality, social solidarity and participation. The article 153 of the law determines that the health insurance must be compulsory, the health providers must have administrative autonomy, and the health users must have free choice of health provider.

Glossary of Acronyms

• SISBEN: Sistema de Identificación de Beneficiarios de Subsidios Sociales (system of identification for social subsidies beneficiaries).
• EPS: Entidades Promotoras de Salud. (Health promoting entities)
• EPS-S: Entidades Promotoras de Salud Subsidiadas. (Subsidized Health promoting entities).
• IPS: Instituciones Prestadoras de Servicios de Salud. (Health providing institutions)
• ESE: Empresas Sociales del Estado. (Statal social organizations)
• ESS: Empresas Solidarias de Salud. (Health solidarity organizations)
• CCF: Cajas de Compensación Familiar. (Family welfare financial institutions)
• POS: Plan Obligatorio de Salud. (Compulsory plan of health)
• Fondo SYGA or FOSYGA: Fondo de Solidaridad y Garantía. (Fund of Solidarity and guarantees)
• MAPIPOS: Manual de Procedimientos y Actividades del POS. (POS-related procedures and activities handbook)
• SOAT: Seguro Obligatorio de Accidentes de Tránsito (Compulsory Auto insurance

SISBEN

The System for the Selection of Beneficiaries of Social Programs (El Sistema de Seleccion de Beneficiarios para Programas Sociales), the national system of identification of beneficiaries for social subsidy, classifies the people according to their socio-economic level into 6 strata, being stratum 1 homeless people and extreme poverty and stratum 6 the highest level of affluence.^[12]

Most of the social subsidies and public health programs are focused in the 1 and 2 strata. So, the fraudulent expedition of low level SISBEN carnets is a major problem in the healthcare system, since the regional politicians are often accused of providing these carnets to not really poor people in exchange for votes. This wrong identification of beneficiaries prevents the real poor people from receiving the subsidies designed for them.

EPS

The National Health Superintendent (Superintendencia de Salud) defines which organizations may qualify as EPS according to a number or requirements, including infrastructure, capital, number of users, functionality and covering. The function of the EPS is to sell health service packages to the public, and contract such services with the healthcare-providing institution.

Health professionals and the healthcare system

The health professionals had little or no participation in the development of the reform to the healthcare system. So, basic principles such as cost-benefit, healthcare quality, and implications in the professional health practice were misjudged. The reform of the health system restricted severely the opportunity of the health professionals to hire their services privately, phenomenon that caused a heavy loss of income for the average health practice.

See also

• Health care systems
• List of hospitals in Colombia
• Water supply and sanitation in Colombia

References

1. ^ ^{a b} http://web.unab.edu.co/editorialunab/revistas/medunab/pdfs/ed719.pdf
2. ^ Guia De Atencion Del Dengue
3. ^ Documento Publicado por Salud y Desplazamiento http://pagina.de/desplazados
4. ^ http://www.col.ops-oms.org/docs/estadisticasmps/MORDEDURA%20SERPIENTES%202004.ppt
5. ^ UNICEF / Colombia - niños–niñas–adolescentes–infancia–salud–educación–igualdad–protección–derechos–noticias–juegos–tarjetas–regalos–libros–videos–VIH–sida–foros–vacunación–nutrición - conflicto armado - trabajo infantil–violencia–secuestros–calle - lactancia materna - registro civil - explotación sexual–desplazados - minas antipersonal–publicaciones–pdf–convención–mortalidad–micronutrientes–gestación–maltrato - agua y saneamiento–limitaciones
6. ^ Historia medicina colombiana
7. ^ Historia de la Medicina - Compumedicina
8. ^ SINTITUL-4
9. ^ Historia de la Cirugía. Curso a Distancia
10. ^ ^{a b c} Colombia country profile. Library of Congress Federal Research Division (February 2007). This article incorporates text from this source, which is in the public domain.
11. ^ La Ley 100
12. ^ http://www.iadb.org/sds/doc/776eng.pdf

External links

• (Spanish) Colombian Ministry of Social Security
• World Health Organization (WHO) Colombia
• SaludColombia.com - Health care reform
• Euromonitor on Colombia