Evolution of the Colombian health system: What remains of Law 100 of 1993?

Abstract

The Colombian reform of health system, adopted by Law 100 of 1993, constitutes a public policy with great pretensions and significant institutional and financial changes. The main goal refers to universal insurance coverage, financed with public resources, with a state direction and an administration entrusted to health promotion companies, who are responsible for guaranteeing access to the health benefits plan through the institutions that provide services. From this baseline, a look at the main regulatory changes is developed to answer the question of how much the system adopted by Law 100 has changed. As far as insurance is concerned, the system remains intact and has rather been strengthened, seeking universal coverage and improvements in access. The main changes have been in financing. After a cycle with low government contributions, since 2010 there have been greater fiscal resources and a lower share of contributions. On the institutional side, some improvements are presented, such as the creation of the entity that administers the resources of the system and the Institute for Technological Evaluation in Health, as well as the strengthening of price regulation and pharmaceutical policy, but the disappearance of the national council and the regulatory commission is a loss, which means a weakening of governance.