Luces y sombras de la reforma de la salud en Colombia: Ley 100 de 1993
Increased insurance coverage, lower out-of-pocket expenses, greater access to a first consultation among the insured population, and the highest number of check-up consultations are important achievements that have been documented by various studies, almost all of them based on secondary data from Quality of Life and Health Demography Surveys.
However, several of those findings have been inflated for various reasons. When you take into account the size of the different Standardized Package of Services (SPS), you need to deflate the net increase in insurance and when you speak of the highest access to services by the insured population over the uninsured, you need to take into account that it is only for the first consultation and that before Law 100 the insured population also accessed health services more.
Further, a very important group of studies shows a series of extremely negative results. The stagnation and decline in preventable death, problems of service quality, the numerous barriers to access to services, and the ethical distortion of professional practice pose serious doubts regarding the result of this reform.
A legitimate question to be asked is whether the positive results achieved, in and of themselves, justify the increased expenditure; another question is, where has this increased expenditure on the health of Colombians gone?
Francisco J. Yepes, Director, Asociación Colombiana de la Salud (Assalud) [Colombian Health Association]
Manuel Ramírez, Universidad del Rosario
Luz Helena Sánchez, Senior Researcher, Assalud
Marta Lucía Ramírez, Associate Researcher, Assalud
Iván Jaramillo, Consultant, Assalud