Impacto de la reforma del sistema de seguridad social sobre la equidad en los servicios de salud en Colombia

Abstract

Para evaluar el impacto sobre la equidad en el acceso y en la utilización de servicios de salud del nuevo Sistema General de Seguridad Social en Salud Colombiano (SGSSS), se compararon dos cortes transversales de la población, antes (1993) y después (1997) de promulgada la Ley 100, de 1993, que lo creó, con respecto a dos indicadores de equidad: las curvas (CC) e índices de concentración (IC) correspondientes a la distribución del aseguramiento y a la utilización de servicios. Entre 1993 y 1997, el IC en el aseguramiento se redujo a la mitad, del 0,34 al 0,17; simultáneamente, la cobertura del SGSSS se incrementó del 23% al 57%, sobretodo entre los segmentos más pobres de la población, donde pasó del 3,1% al 43,7%, como resultado de los subsidios otorgados por los gobiernos locales. Los IC en la utilización de servicios variaron muy poco. Adicionalmente, se detectó una mayor prevalencia de enfermedad y utilización de servicios entre los asegurados, debido a selección sesgada de riesgos y riesgo moral. Estos resultados sugieren un impacto positivo del SGSSS sobre las inequidades en el acceso al aseguramiento; sin embargo, no se evidenció un impacto claro sobre la equidad en la utilización final de servicios.

Time trends in educational inequalities in cancer mortality in Colombia, 1998–2012

“… 4 Citizens are assigned to two major schemes based on income: (1) the contributory scheme, which covers workers and their families with an income above the cut-off and is financed through payroll and employer's contributions; and (2) the subsidised scheme, mainly funded via taxes, which subsidises the poor as identified through a proxy means test. 5 HIC was 23.7% in 1993 just before the reform 6 and rose to 37.7% in 1994, just afterwards. 4 Initially, the coverage improved 4 slowly and a subsequent reform led in 2002 to a noticeable increase in healthcare coverage (reaching around 96% by 2008) by improving efficiency in the use of resources and by reducing its reliance on national budgets 7 ( figure 1 ).…”

The public health impact of economic fluctuations in a Latin American country: mortality and the business cycle in Colombia in the period 1980–2010

“…In Colombia, financial resources may have been more important to access sophisticated and expensive therapies in the first period, during which health insurance coverage was limited. In contrast, in the second period, the expansion of health insurance coverage [ 24 , 25 ] implies that individuals may more easily have access to these therapies irrespective of the business cycle. This may explain the shift from countercyclical to acyclical mortality for older males between the first and second period.…”

“…Since the early 1990’s, Colombia also initiated a major health care reform culminating in the introduction of mandatory health insurance coverage in 1993 [ 24 ]. The reform assigned citizens to either a contributory scheme (for employed workers and their families) or a subsidized scheme (for poor individuals not in formal employment and their families) and led to an increase in health insurance coverage from 23.7 % in 1993, to 93.4 % by 2009 [ 25 ], mostly attributable to an increase in subsidized insurance coverage from 2000 onwards [ 24 ]. In addition, social expenditure per capita tripled from 1991 to 2008, reflecting an expansion of social protection programs for vulnerable Colombians [ 26 ].…”

Factors associated to infant mortality in Sub-Saharan Africa

“…The first two factors are key for health policy planning. It has been demonstrated in several studies that equal access to health services is increased in Social Security Systems , 17 resulting in a larger number of people who are receiving appropriate health care, especially children and mothers. There is a new perspective on the development of health systems based on Social Security financing in several African countries.…”