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Healthcare in Colombia

Lauren Tanskanen

Davenport University

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Background

Health system reform

Creation of laws, plans, and frameworks

Zika virus

Public vs private healthcare

Comparison to US healthcare

Strengths of US and Colombian healthcare

Weaknesses of US and Colombian healthcare

Conclusion

Overview

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Fourth largest country in South America

Population of over 46 million people of numerous ethnicities

Continuing a 40 year campaign to overthrow Colombian government (Nations Online, 2016)

Continuous violence has displaced over 5 million people, causes many injuries and death, and has forced closure of institutional services (UKTI, 2009)

Poor health situation with an aging population, decline in fertility rate, and rapid urbanization (WHO, 2014)

Colombia – Background information

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Major health system reform in 1993

Ruled that health system become self-sustainable by sale of services

Health insurance became two subsystems: contributory and subsidized

Contributory – private, employees pay 25% and employers pay 75%

Subsidized – public, for those that are unemployed or cannot afford insurance (Alvarez, n.d.)

Coverage increased from 21 to 85% (UKTI, 2009)

Healthcare GDP increased from 4.5 to 8.5% (Alvarez, n.d.)

Began to close gap in healthcare equality between socioeconomic classes (Gomez, Jaramillo, & Beltran, 2013)

Health system reform

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In 1993 there was a health system reform in Colombia. The reform ruled that the health system become self-sustainable by the sale of services. Public hospitals and health centers would no longer receive financing from the state and would need to compete with private institutions for contracts with insurance companies. At this time individual insurance became defined by two subsystems: the contributory subsystem and the subsidized subsystem. The contributory subsystem covers those who can afford to pay. The employee contributes 25% and the employer contributes 75% of the cost of insurance. The subsidized subsystem is coverage for those who are unemployed or cannot otherwise afford health insurance. The state covers some of the cost through a subsidy. It is estimated that 30% of the population has health insurance via the subsidized subsystem.

Although the reform seems poor in the eyes of many, the population insurance coverage increased from 21% to 85% from pre-reform to 2007. This means that 15% of the population still does not receive and health insurance coverage which accounts for about 6 million people, most of which live in rural areas or deprived parts of cities (UKTI, 2009). After the reform the GDP toward healthcare increased from 4.5% to 8.5%. Health insurance has become one of the most profitable industries in Colombia and the health insurance companies use that profit to invest in other financial sectors throughout Colombia and abroad (Alvarez, n.d.).

Although the gap has been closing in regards to health equality between the socioeconomic classes, one study showed that there is still inequality in five dimensions of health. These dimensions are health condition, social health insurance coverage, health service utilizations, healthcare quality, and health expenditures (Gomez, Jaramillo, & Beltran, 2013).

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2011 – WHO and PAHO created Country Cooperation Strategy agenda (WHO, 2014)

2012 – 10-year Public Health Plan created (Minsalud, 2016; WHO, 2014)

2012 – WHO and PAHO helped create the United Nations Development Action Framework for Colombia

2013 – two legal processes: Statutory Law and Ordinary Law (WHO, 2014)

Creation of laws, plans, and frameworks

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The Pan American Health Organization (PAHO) and World Health Organization (WHO) were involved in creating the Country Cooperation Strategy agenda for Colombia in 2011. The agenda consists of four different priorities related to health in Colombia. The first priority is aimed toward strengthening the health authority in order to develop public policies that reduce health inequality by targeting the social determinant risk factors. The second priority is aimed toward strengthening the Colombian Health System based on Primary Health Care. This is needed to improve the access, quality, and timeliness of care as well as the economic sustainability and the health impact. The third priority is aimed toward confronting the health challenges associated with the changes in the environment, demographics, and epidemiology. The fourth and final strategy is aimed at strengthening the international cooperation and relations so Colombia can meet their health goals.

In 2012 Colombia created a 10-year Public Health Plan. This plan addresses health as a right, different approaches to healthcare for different populations, and the conceptual model which is based on the social determinants of health (WHO, 2014). There are two objectives of the 10-year Public Health Plan. The first is to address the social determinants of health and the health inequalities in early childhood and adolescence, aging and old age, health and gender, health in varying ethnic populations, disability, and those that are victims of armed conflict. The second objective is to encourage good management practices and to increase capacity in order to promote social mobility in all sectors, the participation of civil society and organized groups in planning and control of interventions and resources, and controlling conflicts of interest. This includes strengthening the health authority for regulation, leadership, financial management, monitoring the social security system, epidemiological and health surveillance, social mobilization, implementation of collective action, and the guarantee of assurance and provision of healthcare. This is needed in order to restore the basic competencies of the health authority and to locally act as planners and action integrators of healthcare (Minsalud, 2016).

The WHO and the PAHO both actively participated in the creation of the United Nations Development Action Framework (UNDAF) of Colombia in 2012. The UNDAF is composed of four areas for the cooperation of health: the struggle against poverty and social inequality, environmental sustainability and disaster management, strengthening democratic governance, and progressing toward peace and security (WHO, 2014).

As of 2013 there are now two legal processes that the Colombian health system is subject to. The first is a Statutory Law which establishes the fundamental right to health. The second is an Ordinary Law that attempts to define the structure, operation, competencies, and resources of the system (WHO, 2014).

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WHO recently declared Zika virus a global health emergency

Colombia has the second most number of cases behind Brazil

Estimated 80,000-100,000 cases in Colombia, most unreported

Infected pregnant mothers may have children born with microcephaly and congenital deformations

Prevention is the first step to controlling virus

Dr. Alvaro Casallas, an MD, and Maria Rozo, a vector expert, made an urgent call to implement a public health program for defense against the virus (CCS, 2016)

Zika virus

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Public vs private healthcare

Public

Primarily serves those who have subsidized insurance

Usually poor quality

Nobody gets turned away which leads to overcrowding

Worse outcomes (Webster, 2012)

Less accessible (InterNations, 2016)

Private

Primarily serves those who have contributory insurance

High quality

State of the art facilities and equipment – among the best in South America (InterNations, 2016)

Better outcomes (Webster, 2012)

Obey all of the quality standards

Many firsts in terms of successful transplants (InterNations, 2016)

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Comparison to US healthcare

Similarities

System – mixed market (Webster, 2012)

Coverage – 85-90% total (Alvarez, n.d.; KFF, 2016)

High levels of corruption (Sparrow, 2006; Webster, 2012)

Differences

Quality – variable in Colombia depending on insurance type, high quality in US (Dayaratna, 2012)

GDP health allocation – 6.8% in Colombia, 17.1% in US (WHO, 2013)

Healthcare is a right in Colombia, not a right in the US (Webster, 2012)

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Strengths of both healthcare systems

Strengths
US Colombia
Access to high quality services Access to high quality services for those that have contributory insurance
Overall good coverage (Cooper & Taylor, 1997) Overall good coverage
No denial of insurance (Obamacare Facts, n.d.) No denial of insurance
Leading in clinical research State of the art facilities and equipment
Major technological breakthroughs Low out-of-pocket expenditures (Ribe, Robalino, & Walker, 2012)
Large number of physicians with many specialties (Cooper & Taylor, 1997).

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Weaknesses of both healthcare systems

Weaknesses
US Colombia
High cost of healthcare Low quality services for those who have subsidized insurance
High overhead costs High prescription costs
Poor outcomes compared to other developed countries Poor outcomes for those that have subsidized insurance
Uneven distribution of physicians Uneven distribution of quality care
Financial incentives to encourage high cost treatment (Cooper & Taylor, 1997) Financial incentives to encourage high cost treatment (Ribe, Robalino, & Walker, 2012)

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Conclusion

The reform of 1993 improved healthcare coverage and access

Two insurance systems were created: contributory and subsidized (Alvarez, n.d.)

Many similarities between the US and Colombian healthcare

Similar strengths and weaknesses between the US and Colombian healthcare

Strong foundations

Potential to be great

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References

Alvarez, L.S. (n.d.). Columbian health system reform. Global Health Watch. Retrieved from

http ://www.ghwatch.org/sites/www.ghwatch.org/files/columbia.pdf

CCS. (2016). Prevention is key to mitigating virus Zika. Colombian Security Council. Retrieved from http://ccs.org.co/salaprensa/index.php?option=com_content&view=article&id=648:zika&catid=336:noticias-febrero-2016&Itemid=875

Cooper, E., & Taylor, L. (1997). Comparing health care systems. Good Medicine. Retrieved from http://www.context.org/iclib/ic39/cooptalr/

Dayaratna, K.D. (2012). Studies show: Medicaid patients have worse access and outcomes than the privately insured. The Heritage Foundation. Retrieved from http://www.heritage.org/research/reports/2012/11/studies-show-medicaid-patients-have-worse-access-and-outcomes-than-the-privately-insured

Gomez, F.R., Jaramillo, T.Z., & Beltran, L.G. (2013). Columbian health care system: Results on equity for five health dimension, 2003-2008. Pan American Journal of Public Health. Retrieved from http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=23452&Itemid

InterNations. (2016). Healthcare and insurance in Colombia. InterNations. Retrieved from https ://www.internations.org/colombia-expats/guide/living-in-colombia-17429/healthcare-and-insurance-in-colombia-2

KFF. (2016). Health insurance coverage of the total population. Kaiser Family Foundation. Retrieved from http ://kff.org/other/state-indicator/total-population/

Minsalud. (2016). Ten-year Public Health Plan. Minsalud. Retrieved from https :// www.minsalud.gov.co/English/Paginas/Ten-year-public-health-plan.aspx

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References cont.

Nations Online. (2016). Colombia. One World Nations Online. Retrieved from http://www.nationsonline.org/oneworld/colombia.htm

Obamacare Facts. (n.d.). ObamaCare pre-existing conditions. Obamacare Facts. Retrieved from http://obamacarefacts.com/pre-existing-conditions/

Sparrow, M.K. (2006). Corruption in health care systems: The US experience. Harvard Kennedy School. Retrieved from http://www.hks.harvard.edu/fs/msparrow/documents--in%20use/Corruption%20in%20Health%20Care--The%20US%20Experience--TI%20Global%20Report%20on%20Corruption--2006--pp16-22.pdf

Ribe, H., Robalino, D.A., & Walker, I. (2012). From right to reality: Incentive, labor markets, and the challenge of universal social protection in Latin America and the Caribbean. Retrieved from https://books.google.com/books?id=gbbDnGBVtPsC&pg=PA185&lpg=PA185&dq=strengths+and+weaknesses+of+colombian+healthcare&source=bl&ots=W4vsAlIQoL&sig=rM8AfGzGW_LiN3U5N5MvupRkAPo&hl=en&sa=X&ved=0ahUKEwiG6ry8z4TLAhXFHB4KHTscDhIQ6AEINzAE#v=onepage&q=colombia&f=false

UKTI. (2009). General summary of the healthcare market in Colombia. Association of British Healthcare Industries. Retrieved from www.abhi.org.uk/.../e.../ colombiahealthcare _market_in_ colombia .doc

Webster, P.C. (2012). Health in Colombia: A system in crisis. CMAJ. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314050/

WHO. (2013). Health financing. World Health Organization. Retrieved from http://gamapserver.who.int/gho/interactive_charts/health_financing/atlas.html

WHO. (2014). Colombia. World Health Organization. Retrieved from http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_col_en.pdf

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