Assesing Health Services in Colombia: Development of a Conceptual Framework and Measurement tools based on primary data

Marcela Arrivillaga

doi:10.1177/21582440211016844

Abstract

Colombia has a mixed public-private health care system, and although official data indicate more than 95% of health coverage, research in this field has demonstrated the persistence of barriers to accessing health care services. This study aimed to analyze the conceptual framework of health services accessibility and develop measurement tools for its assessment using primary data and also to propose a method for ascertaining health services accessibility and availability using a territory-based approach. A mixed method study with concurrent design was carried out in four phases between 2014 and 2017. The starting points were a review of the literature and a documentary research that identified five conceptual frameworks for health services accessibility published between 1970 and 2013. It was found that the theoretical concept of health services availability has not been clear; the literature does not define it explicitly and does not differentiate it from the concept of health coverage. As a result, two measurement tools were developed: a Health Care Services Accessibility Household Survey and a Health Care Services Availability Questionnaire. These tools and the proposed method for ascertaining health services accessibility can be useful for government, institutions, and social and scientific organizations to monitor progress in guaranteeing the fundamental human right to health, declared in the Health Organic Law issued in 2015 in Colombia.

Highlights

Colombia has a mixed health care system, with medical and health services provision, parallel public and private financing and insurance intermediaries called Health Promoting Enterprises (EPS, as per its acronym in Spanish) that manage the resources
In 2001, the nation failed to meet its Universal Health Coverage (UHC) overall goal and reached only 60% of the population (Ministerio de Salud y Protección Social, 2018); in July of 2020 this coverage was 96.33% (Ministerio de Salud y Protección Social, 2018), which means a substantial advance in terms of health system performance in the nation
The documents were classified into five categories/frameworks: accessibility to health care services in terms of (a) the decent minimum of health care, (b) the health care market, (c) factors and multicausality, (d) needs, and (e) social justice and the human right to health (Arrivillaga & Borrero, 2016)

Summary

Introduction

Colombia has a mixed health care system, with medical and health services provision, parallel public and private financing and insurance intermediaries called Health Promoting Enterprises (EPS, as per its acronym in Spanish) that manage the resources. Despite reforms made to the system since its implementation in 1993, different sectors of Colombian civil society have criticized the structure and organization of the system due to persistent differences between UHC data and real accessibility to health services. “Bureaucratic itineraries,” as these barriers have been called by experts on the Colombian health system, persist (Abadia & Oviedo, 2009). When people enter the services, they face complex and excessive administrative procedures and difficulties accessing care, with delays in allocation of medical appointments and in diagnosis, treatment, and authorization for medicines delivery. In Colombia, legal actions (Tutelas in Spanish) against the health system due to poor access to health care services have been increasing, reaching a record of 617,071 in 2016.

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Discussion

Conclusion