Health in Colombia

Health 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.

Status of public health

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 percent (pre-1993) to 56 percent in 2004 and 66 percent in 2005, health disparities persist, with the poor continuing to suffer relatively high mortality rates. 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 population, respectively. In 2005 Colombia was reported to have only 1.1 physicians per 1,000 population, as compared with a Latin American average of 1.5. The health sector reportedly is plagued by rampant corruption, including misallocation of funds and evasion of health-fund contributions. [http://lcweb2.loc.gov/frd/cs/profiles/Colombia.pdf Colombia country profile] . Library of Congress Federal Research Division (February 2007). "This article incorporates text from this source, which is in the public domain."]

General government spending on health accounted for 20.5 percent of total government expenditures and for 84.1 percent 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.

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.

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 percent of those requiring it).

Law 100 of 1993

The law 100 of 1993 established a new legislation of health care in Colombia. This law 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: Acronym for Sistema de Identificación de Beneficiarios de Subsidios Sociales (system of identification for social subsidies beneficiaries).

EPS: Entidades Promotoras de Salud. (Health promoting Entrepreneurships)

EPS-S: Entidades Promotoras de Salud Subsidiadas. (Subsidied Health promoting entrepreneurship)s

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) is the national system of identification of beneficiaries for social subsidy clasiffies the people according with their socio-economic level into 6 strates, being strate 1 homeless people and extreme poverty and strate 6 the highest level of richness. [http://www.iadb.org/sds/doc/776eng.pdf]

Most of the social subsidies and public health programs are focused in the 1 and 2 strates. So, the fraudulent expedition of low level Sisben carnets are 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 to receive the subsidies designed for them.

EPS

The National Health Oversight (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. However, many EPS have been implicated with insufficiency of the operative network, corruption and denying of basic services.

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
* Medicine in Colombia
* "Ley 100"
* Pharmaceuticals industry in Colombia
* Water supply and sanitation in Colombia

External links

* [http://www.minproteccionsocial.gov.co/VBeContent/home.asp Colombian Ministry of Social Security]
* [http://www.who.int/countries/col/en/ World Health Organization (WHO) Colombia]
* [http://www.saludcolombia.com/actual/lareform.htm SaludColombia.com - Health care reform]
* [http://www.euromonitor.com/OTC_Healthcare_in_Colombia Euromonitor on Colombia]

References

*Congreso de Colombia. Ley 100 de 1993. Por la cual se crea el Sistema de Seguridad Social Integral y se dictan otras disposiciones. Bogotá, diciembre 23 de 1993.
*Jaramillo-Pérez I. El futuro de la salud en Colombia. Bogotá, FESCOL, 1994.
*Superintendencia de Subsidio Familiar. Circular a directores administrativos de cajas de compensación. Diciembre de 1994.
*Ministerio de Salud. Resolución 5261 de agosto 4 de 1994.
*Superintendencia Nacional de Salud. Circular 037 de 1994 a representantes legales, juntas directivas e instituciones interesadas en obtener la autorización y certificado de funcionamiento como entidades promotoras de salud.
*Ministerio de Salud. Decreto 1980 de 1995.
*Fundación Social. Las formas de contratación entre prestadoras y administradoras de salud. Sus perspectivas en el nuevo marco de la seguridad social. Bogotá, 1995.