Health system of Colombia

from Wikipedia, the free encyclopedia
A psychiatric doctor prepares electroconvulsive therapy in the psychiatric ward at Federico Lleras Acosta in Ibagué .

The health system of Colombia includes prevention, treatment and process support for physical and mental illnesses.

Health risks

Tropical diseases are a serious problem in Colombia because they are one of the leading causes of death. Malaria affects nearly 85% of the country, mainly on the coast of the Pacific Ocean , the Amazon rainforest, and the eastern savannas. There are around 250,000 infections per year and a mortality rate of 3 per 100,000 inhabitants. The main pathogen is Plasmodium vivax , with a share of 66% of the cases, with the pathogen Plasmodium falciparum predominating on the Pacific coast and responsible for 75% of the cases. Yellow fever and dengue fever are the major health risks due to their high epidemic potential, high mortality and the widespread distribution of the yellow fever mosquito . The Colombian government therefore regularly carries out vaccination campaigns against yellow fever.

The lance viper Bothrops atrox is the leading cause of deaths from snake bites in Colombia.

The Chagas disease is especially endemic in Departamento de Santander and in the nearby areas. Pathogens such as leishmania , rabies virus and West Nile virus are just as common in Colombia. Snake bites are of great concern, largely due to the nationwide shortage of antivenin supplies.

Various forms of malnutrition have major effects on the health of the population, especially children under five. About 21% of these children suffer from malnutrition and about 23% from iron deficiency anemia .

history

Beginnings of the health system

The first graduate doctor, Álvaro de Auñon, came to the Kingdom of New Granada from Seville , Spain in 1597 and stayed for a short time. The first Colombian pharmacy was opened by Pedro López de Buiza at the same time.

Old map of the New Kingdom of Granada

In 1636, Rodrigo Enríquez de Andrade opened the first medical faculty of New Granada at the Colegio Mayor de San Bartolomé , albeit with moderate success, as prejudices against the medical career were deeply rooted in Spanish culture. Most of the medical care at that time was therefore provided by unskilled healers. The first medical textbook that was written in Colombia was the "Tratado de Medicina y Modelo de Curar en estas partes de Indias" (German: Treatise on medicine and models for healing in these parts of India ) by Pedro Fernandez de Valenzuela from the Year 1662.

In 1740 Vicente Tomás Cansino started a medical program at the Universidad del Rosario . Medical care at that time was almost exclusively limited to the homes of the sick, due to the lack of hospitals. The first hospital in Colombia was the Hospital de San Pedro in the capital Bogotá . The hospital was built by Juan de los Barrios and started operating in 1564. In 1739 the Hospital San Juan de Dios, built by Pedro Pablo Villamor, was opened in the capital.

The first female medical graduate was the Swiss Anna Galvis Hotz in 1877. She had graduated from the University of Bern , because at that time women were still denied access to the university in Colombia. In 1925, the Russian-American Paulina Beregoff was the first woman to graduate from a medical degree at a Colombian university. The first Colombian woman to obtain a medical degree from a university in the country was Inés Ochoa Pérez, who graduated from the Universidad Nacional de Colombia in 1945.

Situation since 1980

Health standards in Colombia have improved a lot since 1980. The 1993 health reform changed the financial basis of the health system and shifted the burden of subsidization from health care providers to insured people. As a result, employees were required to pay into the health system, with employers also having to pay. Although the new system has significantly increased the number of people insured by health and social security from 21% before 1993 to 56% in 2004 and 66% in 2005 and has improved access to health care, large health inequalities still persist among the population, which is still evident it shows that poorer people continue to suffer from higher mortality rates.

The Refractive Surgery keratectomy was developed by Ignacio Barraquer in Bogota 1964th On January 10, 1985, Elkin Lucena carried out the first successful in vitro fertilization and thus enabled the first Latin American birth of the test tube baby Carolina Mendez. On December 14, 1985, Alberto Villegas performed the first heart transplant in Latin America with the operation on Antonio Yepes .

On May 20, 1994, Manuel Elkin Patarroyo received the Princess of Asturias Prize for his technical and scientific research into the synthetic malaria vaccine .

In 2002, Colombia had 58,761 doctors, 23,950 nurses and 33,951 dentists; these figures correspond to 1.35 doctors, 0.55 nurses and 0.78 dentists per 1000 population. In 2005, Colombia is said to have had only 1.1 doctors per 1000 inhabitants, compared to the Latin American mean of 1.5.

State of public health

The Pablo Tobón Uribe private clinic in Medellín

Government spending on health accounted for about 20.5% of total government spending in 2003 and accounting for 84.1% of total health system costs. The total annual health costs made up about 5.6% of the gross domestic product in 2005 . The per capita expenditure on health services in 2005 amounted to about 150  dollars , according to an average exchange rate.

Urban and rural residents have very unequal access to health care. Health care coverage is around 95% in the three largest cities - Bogotá, Medellín and Cali . Rural residents experience the best health care in the coffee-bean-growing areas . At the lower end of health care coverage, in terms of coverage and quality, are the rural areas of the lowlands and the sparsely populated regions with medium-sized and smaller towns.

Surgery with hip and knee joint replacement in a hospital in Bogotá

Colombia has halved its homicide rate since 2002, starting from one of the highest homicide rates in the world at the time. In 2002 it was 60 kills per 100,000 inhabitants or a total of 28,837, but in 2006 it was only a total of 17,206, the lowest level since 1987. Other causes of death include heart disease, premature death, strokes, respiratory diseases, traffic accidents, and diabetes. In the lowlands and on the coasts, water-related diseases such as malaria and leishmaniasis are prevalent. In 2004, 92% of children under 12 months of age were vaccinated against measles .

AIDS is the fifth leading cause of death for people of working age. According to the national health authority Instituto Nacional de Salud , around 240,000 people or around 0.6% of the population were infected with AIDS in 2003, mostly women and young people. AIDS infection was first registered in Colombia in 1983. It is estimated that 160,000 to 310,000 children and adults were living with HIV in 2005, including 62,000 women aged 15 to 49. Both AIDS and hepatitis B are on the rise. The 2005 estimated HIV prevalence rate for adults (15–49 years) was 0.6%. Between 5,200 and 12,000 people died of AIDS in 2006. Health programs of the “Plan Multisectorial Nacional” ( National Cross-Sectoral Plan ) were launched in 2004 to better care for people with HIV and to provide antiretroviral drugs . This program supplies around 12,000 people. Together with other treated patients, an estimated 54% of all those in need of treatment receive the necessary help.

Law 100 of 1993

The Constitution of Colombia was reformed in 1991. To this end, the general social security system has also been redesigned through Law 100, which has significantly expanded the coverage of health care in the population. However, the financial resources were insufficient to carry out the reform, so many public health facilities collapsed and the wages of many employees in these facilities had to be cut.

Law 100 of 1993 is divided into four books:

The reform of the Colombian health system had three main goals:

  • increasing competition to prevent health monopolies
  • the inclusion of private healthcare providers in the healthcare market
  • the creation of a subsidized health sector to serve the poorest part of the population.

The general principles of the law determine that health care is a public service that must be provided at a high quality level, universally and in solidarity. Article 153 of the law states that health insurance is compulsory, health service providers are administratively autonomous and patients are free to choose their service provider.

Sistema de Identificación de Potenciales Beneficiarios (Sisbén)

The system for the identification of grant recipients ( El Sistema de Seleccion de Beneficiarios para Programas Sociales ) divides people into six classes according to their socio-economic status, with class I belonging to the homeless and people in extreme poverty and class VI the highest degree of wealth.

Most of the subsidy payments are concentrated in classes I and II (and the newly created class 0). The fraudulent distribution and use of SISBEN ID cards with access to subsidies for low grades is currently one of the major problems facing the health system. Regional politicians are often accused of distributing such cards in exchange for votes to people who are not legally entitled to them. Wrong identification to establish claims and political problems challenge the system again and again. This often causes real beneficiaries who are dependent on the subsidies to suffer.

Entidades Promotoras del Servicio de Salud (EPS)

The national health officer ( Superintendencia de Salud ) defines which organizations meet the EPS criteria, i.e. which organizations are health promoting institutions. Criteria include infrastructure, capital, number of patients, range and services.

Some EPS organizations offer a Plan Complementario that includes preferential treatment and major reimbursement.

Most EPS organizations also offer Medicina Prepagada , which guarantees the patient the best possible care with the best care and a higher priority at significantly higher costs.

Doctors in the health system

As of October 1, 2014, there were 3,620 healthcare facilities in Colombia, including hospitals, clinics and outpatient services. Private health facilities accounted for 57% of all facilities in the country.

Although no city or state is the sole center of national health care and the structure is federal, 80% of health facilities are located in 16 of the 39 states.

The higher skilled health workers had little or no influence on the development and reform of the health system. Correspondingly, basic principles such as the cost-benefit ratio, quality of health care and implications in professional practice were misjudged during the reform. The reform of the health system limited the ability of medical professionals to offer their services only privately, resulting in a severe loss of income for the average employee.

Glossary of Acronyms

  • SISBEN: Sistema de Identificación de Beneficiarios de Subsidios Sociales (system for the identification of grant recipients).
  • EPS: Entidades Promotoras de Salud (Health Promoting Institutions)
  • EPS-S: Entidades Promotoras de Salud Subsidiadas (Subsidized Health Promoting Organizations).
  • IPS: Instituciones Prestadoras de Servicios de Salud (Health Institutions )
  • ESE: Empresas Sociales del Estado (State Social Institutions)
  • ESS: Empresas Solidarias de Salud (solidarity health organizations)
  • CCF: Cajas de Compensación Familiar (family facilities)
  • POS: Plan Obligatorio de Salud (Compulsory Health Contract)
  • Fondo SYGA or FOSYGA: Fondo de Solidaridad y Garantía (Solidarity and Guarantee Fund)
  • MAPIPOS: Manual de Procedimientos y Actividades del POS (manual for POS processes and activities)
  • SOAT: Seguro Obligatorio de Accidentes de Tránsito (Compulsory Car Insurance )

See also

Web links

Individual evidence

  1. ↑ web.unab.edu.co ( Memento from May 29, 2008 in the Internet Archive ) (PDF)
  2. ↑ Guia De Atencion Del Dengue
  3. ↑ Documento Publicado por Salud y Desplazamiento
  4. ↑ col.ops-oms.org ( Memento from September 26, 2007 in the Internet Archive )
  5. ↑ UNICEF Nutrición Infantil y Micronutrientes ( Memento of February 22, 2008 in the Internet Archive )
  6. ↑ Historia medicina colombiana ( Memento from January 2, 2010 in the Internet Archive )
  7. ↑ Historia de la Medicina - Compumedicina ( Memento of February 3, 2007 in the Internet Archive )
  8. ↑ SINTITUL-4 ( Memento of March 7, 2008 in the Internet Archive )
  9. ↑ Historia de la Cirugía. ( Memento from March 9, 2007 in the Internet Archive )
  10. ^ Colombia country profile (PDF).
  11. ↑ Ley 100 de 1993 Nivel Nacional alcaldiabogota.gov.co, accessed June 15, 2017 (Spanish)
  12. ↑ La Ley 100 ( Memento from September 28, 2007 in the Internet Archive )
  13. ↑ iadb.org ( Memento of the original from May 29, 2008 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.iadb.org
  14. ↑ eltiempo.com
  15. ↑ youtube.com
  16. ↑ youtube.com
  17. ↑ Ministerio de Salud minsalud.gov.co/salud/Paginas/rips.aspx, accessed on April 13, 2019 (Spanish)
  18. ^ Global Health Intelligence .