Temas Socio-Jurídicos. Volumen 18 No. 38 Junio 2000

La revista Temas Socio-Jurídicos en su edición número 38, quiere destacar la lucha del pueblo U’WA por su supervivencia étnica y cultural; por tal razón hemos dedicado nuestra portada a un exponente de la comunidad, así como el artículo escrito por Javier Vesga Flórez, sobre los problemas generados a la comunidad U‘wa por el proyecto petrolífero del Bloque Samoré.The Socio-Legal Issues magazine in its 38th edition wants to highlight the struggle of the U'WA people for their ethnic and cultural survival; For this reason, we have dedicated our cover to an exponent of the community, as well as the article written by Javier Vesga Flórez, about the problems caused to the U‘wa community by the oil project of the Samoré Block

Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: A comparative risk assessment

Background: High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. Methods: We used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses of large prospective studies. We calculated the population attributable fractions for each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final estimates. Findings: In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10·8 million deaths, 95% CI 10·1-11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6-7·6) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined effects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. Interpretation: The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing effect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the global response to non-communicable diseases. Funding: UK Medical Research Council, US National Institutes of Health. © 2014 Elsevier Ltd

Overcoming social segregation in health care in Latin America

Latin America continues to segregate different social groups into separate health-system segments, including two separate public sector blocks: a well resourced social security for salaried workers and their families and a Ministry of Health serving poor and vulnerable people with low standards of quality and needing a frequently impoverishing payment at point of service. This segregation shows Latin America's longstanding economic and social inequality, cemented by an economic framework that predicted that economic growth would lead to rapid formalisation of the economy. Today, the institutional setup that organises the social segregation in health care is perceived, despite improved life expectancy and other advances, as a barrier to fulfilling the right to health, embodied in the legislation of many Latin American countries

Caso de Estudio: VIH/SIDA en el Contexto de la Reforma a la Salud en Colombia

A comienzo de los noventa, Colombia, el tercer país con mayor población en Latinoamérica, implementó una profunda reforma de su sistema de salud. Se creó un seguro universal de salud. Este sistema recauda fondos de manera central, y paga una cantidad de dinero per-capita ajustada por riesgo a entidades que compiten entre sí por adiliados. Estas entidades privadas son responsables por asegurar acceso a un paquete de servicios de salud básico y definido por ley. El caso aquí presentado estudia cómo se manejó la epidemia de VIH/SIDA en Colombia en el contexto de la Reforma a la Salud. La inclusión de Antiretrovirales (ARV) en el paquete básico de salud se constituyó en un mecanismo poderoso para asegurar el acceso a tratamiento. Los resultados son menos claros y en cierta medida desesperanzadores en lo que corresponde a actividades de prevención.Starting in the early nineties, Colombia, the third most populous country in Latin America, implemented a profound reform of its health system. A universal social health insurance system was created. The new system collects funds centrally, and allows for multiple competing plans that receive risk adjusted capitated payments and are responsible for delivering a basic and legally mandated basket of services. This case reviews how the HIV/AIDS epidemic has been managed in the context of this reform. The inclusion of Antiretroviral (ARV) in the mandated basic basket proved a powerful mechanism for ensuring access to care. Results are less clear, and to some extent disappointing, for prevention activities

Design and Reform of the Mandatory Benefits Package in the Colombian Health System

La forma de diseñar e implementar los planes de beneficios en salud es tan importante como lo son sus contenidos. El presente artículo se enfoca en consideraciones asociadas al diseño de los planes. Comienza por definirlos, expone las diferentes maneras de diseñarlos y las implicaciones que éstas tienen sobre la equidad, y sobre el acceso a los servicios y su exigibilidad. Se presentan experiencias internacionales de diseño e implementación de planes, con énfasis en las reformas recientes de Chile y México. Los conceptos y casos expuestos se contextualizan en la coyuntura colombiana actual, con lo cual se plantean reflexiones y alternativas para el proceso actual de reforma del Plan Obligatorio de Salud (POS).The way a benefits package is implemented in a health system is as important as its content. This article focuses on the way a package is designed and implemented, rather than on its medical content. It starts by defining the packages and presenting the different ways of designing them, and the implications of the latter on equity and access. Some international experiences are presented and commented, with special emphasis on recent reforms in Chile and México. The concepts and cases presented in the paper are then discussed in the Colombian context in order to identify relevant lessons and insights for the current process of reforming and updating the Colombian benefits package

Requerimientos patrimoniales de las aseguradoras en salud bajo diferentes pagos de capitación ajustados por riesgo

Resumen: La definición de los requerimientos patrimoniales de las aseguradoras en salud es un tema de interés para los hacedores de política. Estos requerimientos definen la probabilidad de insolvencia y la cantidad mínima de afiliados que deben tener las aseguradoras para controlar el riesgo de insolvencia del sistema. En este artículo desarrollamos una metodología para estimar la pérdida esperada de las aseguradoras considerando su perfil específico de riesgo y la fórmula con la que se calculan los pagos de capitación. Asumimos que la pérdida esperada sigue una distribución normal dentro de unos grupos de riesgo definidos por la combinación única de sexo, ubicación, grupo de edad, y enfermedad de larga duración, y luego definimos el patrimonio óptimo como el primer percentil de la distribución de pérdida. Hacemos una aplicación a las aseguradoras del régimen contributivo del sistema de salud colombiano.Defining optimal capital requirements for health insurers is a matter of interest for policy-makers. They determine the insolvency probability of health insurers and the minimum number of enrolees in order to keep insolvency under control. In this paper we develop a methodology for estimating the expected loss per health insurer after considering their specific risk profile and the capitation formula with which they are paid. We assume the expected loss follows a normal distribution within risk pools consisting of a unique combination of long-term disease, age, gender, and location, and then define the minimum capital requirement as the 1st quantile of the loss distribution. An application is made for insurers in the statutory health care system of Colombia

Escenarios posibles para el Sistema General de Seguridad Social en Salud (SGSSS)

El documento hace un análisis descriptivo y comparativo entre distintos elementos de tres escenarios (un modelo estatizado, privatizado o combinado) hacia los cuals puede evolucionar el Sistema general de Seguridad Sociel en Salud (SGSSS) de Colombia. La presentación de estas distintas perspectivas tiene el objetivo de fundamentar un debate público informado sobre las dificultades presentes en el sistema de salud actual y qué se puede hacer al respecto. Dentro de los elementos de cada escenario, se hace mención a mecanismos de financiación, vigilancia (regulación), qué beneficios abarca la afiliación al sistema, entre otros.This document presents three alternative health systems models (totally public, totally privatized, or combined). These are presented as scenarios toward which the Colombian health system could evolve in the future. The presentation of these different perspectives aims to inform the public debate about the difficulties present in the current healthcare system and what direction could its design take in the future. Among the elements of each scenario, we mention the funding mechanisms, service delivery models, monitoring, regulation, and the benefits that covered by the system, among others

Measuring out-of-pocket health expenditure using Colombia´s

:En este documento se proponen tres metodologías de cálculo del gasto de bolsillo en salud con base en la Encuesta Nacional de Calidad de Vida de Colombia. Los resultados muestran que no importando la definición usada el gasto de bolsillo en salud para Colombia presentó una disminución en el periodo 2008-2014, lo que sugiere un continuo mejoramiento de la meta de protección financiera del sistema colombiano de salud.In this paper three different methodologies for calculating out-of-pocket health expenditure are suggested based on the items included in the Living Standard Measurement Study. The results show that out-of-pocket health expenditure decreases in the 2008-2014 period regardless of the approach used, suggesting a continuous improvement on the financial protection goal of the Colombian health system