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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Juan Pablo Uribe, MD, MPH, MPA, Department of Human Development, Latin America and the Caribbean Region, The World Bank, 1818 H Street, NW, Washington, DC 20433, (202)-458-2256, juribe@worldbank.org and Luis G. Morales, MD, MPH, REDSALUD Project, Development Associates, Inc., Calle Angel Severo Cabral No.31, Santo Domingo, Dominican Republic.
In December 1993, the Colombian congress enacted Law 100, radically restructuring the country’s health sector. With this law Colombia sought to leave behind a traditionally fragmented and inefficient health system and move towards an innovative model of “managed competition” that would ensure universal coverage based on demand-side subsidies. Eight years after enactment, and six years into implementation, it is worth asking about results achieved and lessons learned from this aggressive, structural reform that once captured enormous international attention and debate. Here we review several outcomes of such reforms. It is clear that there have been significant improvements in equitable financing, insurance coverage, and access. Quality of care, as measured by key morbidity, mortality and user satisfaction indicators, shows considerable progress. A recent study of public hospitals in Bogota, for example, revealed progress in terms of institutional modernization, transparent management, and a reduction of corrupt practices. Despite such gains, the reform agenda faces several challenges. Inclusion of informal workers as premium-paying beneficiaries remains elusive. In addition, general and institutional efficiency has been compromised by slow bureaucratic change and elevated transaction costs, resulting from complex resource flows.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.