Rosa Rodríguez-Monguió, Alberto Infante Campos
Pan American Health Organization/World Health Organization and The World Bank, 525, 23th street, Washington, DC 20037, USA.
Health Policy. 2004 May;68(2):129-42. doi: 10.1016/j.healthpol.2003.10.004.
Colombia's 1991 Constitution reformed the country's public health care system. Per constitutional mandate: (subsequently developed by Law 60/1993 and Law 100/1993), (1) health is a right of all citizens, (2) the Social Security System must coordinate, provide and control an effective, universal and collective public health service, (3) health services management and delivery are decentralized to strengthen the role of departments and municipalities, (4) the private sector is incorporated within the insurance and health services delivery functions, and (5) basic health services are free and compulsory. After summarizing some of the most relevant Colombia's health system features, this article addresses four central aspects of the country's health care reform, namely: (1) the Unit of Payment by Capitation (UPC) as a provider payment mechanism, (2) asymmetries of information among the different agents of the General System of Social Security in Health (SGSSS), (3) the delegation by the Fund of Solidarity and Assurance (FOSyGA) of collection and control functions to Health Promotion Entities (EPS), and (4) the attempt to achieve universal health insurance as defined by Law 100. The article concludes with a description of various measures and political decisions necessary to ameliorate the financial crisis of the SGSSS and overcome difficulties in reform implementation.
哥伦比亚1991年宪法对该国的公共医疗体系进行了改革。根据宪法规定（随后由第60/1993号法律和第100/1993号法律进一步完善）：（1）健康是所有公民的一项权利；（2）社会保障体系必须协调、提供并管控一项有效、普及且集体性的公共医疗服务；（3）医疗服务的管理与提供实行权力下放，以强化各部门和各市镇的作用；（4）私营部门被纳入保险及医疗服务提供职能之中；（5）基本医疗服务免费且具有强制性。在总结了哥伦比亚医疗体系的一些最相关特征之后，本文探讨了该国医疗改革的四个核心方面，即：（1）按人头付费单位（UPC）作为一种提供者支付机制；（2）健康社会保障总体系（SGSSS）不同主体之间的信息不对称；（3）团结与保障基金（FOSyGA）将征收和管控职能委托给健康促进实体（EPS）；（4）按照第100号法律的定义实现全民医疗保险的尝试。文章最后描述了改善SGSSS金融危机及克服改革实施困难所需的各种措施和政治决策。
