Sistema de salud en Colombia: 20 años de logros y problemas

Abstract

Sistema de salud en Colombia: 20 años de logros y problemasThe Colombian healthcare system: 20 years of achievements and problemsResumen Se presenta un balance de algunos procesos claves y resultados del Sistema General de Seguridad Social en Salud (SGSSS) en Colombia. Se realizó una revisión sistemática de literatura publicada en revistas indexadas con valoración de la calidad de la evidencia, y literatura no publicada en revistas. Los recursos financieros del sistema de salud, se han incrementado de manera sostenida, mientras el gasto en salud se ha situado alrededor del 8% del PIB. La cobertura, medida por la afiliación a los regímenes contributivo y subsidiado, se encuentra alrededor del 92% de la población total. El Plan Obligatorio de Salud, que define las prestaciones a las cuales se tiene acceso, se ha mantenido con un carácter amplio y ha sido rebasado por mecanismos de reclamo jurídico (tutelas), generándose déficits financieros. El sistema de salud ha contribuido al mejoramiento del ingreso de los más pobres, pero persisten las inequidades que provienen de la ausencia de cobertura universal, de las diferencias en los planes de salud y en el gasto del sistema según ingresos de la población. El avance del SGSSS es positivo pero no ha logrado alcanzar la universalidad y se ha estancado en acceso a los servicios y equidad. Palabras clave Sistema de salud, SGSSS, Colombia, Cobertura, Financiación, Equidad Abstract An overview of some of the key processes and results of Colombia's National Health System is presented. A systematic review of the literature evaluating the quality of the evidence published in indexed journals and literature not published in journals was made. Health system financial resources have seen a sustained increase while spending on health has remained at around 8% of GNP. Coverage, measured by affiliation to contributory and subsidized regimes, is in the order of 92% of the total population. The Mandatory Health Plan, defining the benefits to which one has access, has been broadly maintained but has been hampered by mechanisms for making legal complaints, thereby leading to financial deficits. The health system has contributed towards improving the poorest sector's income, but inequalities persist due to the lack of universal coverage, differences in health plans and the system's expenditure according to the population's income. Advances made in the National Health System have been positive but universality has not been achieved and this has stagnated in matters regarding access to services and equality.

Inequities in cervical cancer screening among Colombian women: A multilevel analysis of a nationwide survey

“…Other authors have reported that younger women have reduced probabilities of having Pap test [14,16,25,31,32], especially if residing in rural areas [14]. Although better coverage of subsidised health insurance in rural areas has been reported in Colombia [21], people with subsidised health insurance receive 40% less health care compared to those with contributory health insurance [21]. In this regard, our results also show that women in rural areas with subsidised insurance have a lower probability of having had a Pap test.…”

“…Public teachers and universities workers, members of the military forces, police, and employees of the Colombian Oil Company have special health insurance plans [18]. Differences in access to health care benefits between the contributory and subsidised systems have been reported [19][20][21] which mainly affect disadvantaged populations [19,22,23]. The SGSSS has been criticised for not considering geographical, social, and cultural contexts, increasing barriers to access health care [24].…”

Related Factors to the Use of Oral Health Services Amongst Population Aged 6 to 15 Years in Colombia

“…According to the Overall Performance Report by the World Health Organization (2000), which compares the National Health Systems, Colombia was in 22nd place in health system performance (World Health Organization). Important health reforms introduced in Colombia has increased the number of insured people to the system; nevertheless, this situation did not guarantee an equitable access to the different preventive and curative programs within the different levels of oral health care (Calderón et al, 2011).…”

“…Oral health loose priority is evident when seeking oral professional care only in cases of true dental/oral emergencies. Economic barriers (Calderón et al, 2011) are an important issue due firstly to the cost of commuting to the health center (in this case is associated to geographic barriers) and secondly to the need of payment for a percentage of total service (copayment). It is important to mention that an important part of the Colombian population live in poverty and indigence (Colombia Líder -Fedesarrollo, 2012).…”

Barreras y facilitadores de acceso a los servicios de salud bucal para la población adulta mayor atendida en la red pública hospitalaria de Medellín, Colombia

“…Desde la implementación del Sistema General de Seguridad Social en Salud en el año 1993, y sus posteriores reformas, se han asentado muchas críticas debido principalmente al hecho de que a pesar de que la cobertura en salud aumentó (incremento en el número de personas afiliadas al sistema), se han presentado barreras de acceso a los servicios de salud por limitaciones en los planes de beneficio o por dificultades administrativas, entre otras causas (20). Aunque se han realizado investigaciones que tratan de identificar determinantes que afectan el acceso y la utilización de los servicios de salud (21,22), estudios enfocados en analizar el acceso a los servicios de salud bucal, concretamente, son más escasos en el país, y mucho menos en población adulta mayor (23,24).…”