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Ítem Revisión de Literatura: Justiciabilidad de los Derechos Económicos Sociales y Culturales con Enfoque en el Derecho a la Salud(Centro de Estudios en Protección Social y Economia de la Salud - PROESA, 2017-03-01) Jaramillo, AndreaThe participation of legislative bodies around the world about the Economics, Social and Cultural Rights makes relevant to investigate its justiciability. In the Colombian case, it has been a considerable amount of tutelas to demand rights of this kind, especially in health. In academic debates there is a debate about the participation of judges in those cases. This paper presents a literature review on this topic, particularly in the right to health. To understand the discussion, it is important to know the judicial intervention scope and account for the public cost to guarantee the right. That’s why the discussion involves both lawyers and economist, and what are developed in this paper are precisely those arguments and counterarguments that have been debated on the justiciability discussion.Ítem Gobernabilidad y Gobierno Corporativo en el Sector Salud: Revisión de Literatura(Centro de Estudios en Protección Social y Economia de la Salud - PROESA, 2017-03-01) Benavides Franco, JuliánGovernability is a concept applied to different levels and has different implications depending on the type of organization analyzed. Governability of the health sector implies control organisms, accountability procedures and the organizational structure of the firms that belongs to the system. Traditionally Corporate Governance deals with the relationships between stockholder and administrators, and the ways that stockholders assure a return on their investment. Both the business community and regulatory bodies have produced principles of good government aiming to be applied broadly, with the purpose of increasing confidence of stockholders and promote the investment environment. It is usual to assume that the objective of corporate government is to maximize the value of stockholders, but different types of organizations and ownership consider stockholders or interests groups in their maximization objectives.Ítem Capital requirements of health insurers under different risk-adjusted capitation payments(Centro de Estudios en Protección Social y Economia de la Salud - PROESA, 2017-02-01) Guerrero Carvajal, RamiroDefining 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.Ítem Marcos conceptuales de rendición de cuentas en el sector salud(Centro de Estudios en Protección Social y Economia de la Salud - PROESA, 2016-09-01) Prada Ríos, Sergio IvánThis paper summarizes the main accountability frameworks as applied directly or indirectly to the healthcare sector. It starts with three general frameworks used in the public administration theory, then describes frameworks applied to the provision of public services, and ends with frameworks applied to the medical profession. Specifically ir reviews frameworks for the individual, the hospital, and the provision of primary care and community care. It concludes that the main challenges to design the right accountability framework for healthcare for any given society are: information asymmetry, competing incentives between public and private providers, and lack of institutional capacity of providers and regulators. It is also found that the professional accountability framework is the best alternative, provided that the context is right for its full implementation.Ítem Young Latino Children Obesity: The Importance of Socioeconomic Status, Home Language, TV watching, and Physical Activity(Centro de Estudios en Protección Social y Economia de la Salud - PROESA, 2017-01-01) Galindo, Claudia L.The incidence of young Latino children obesity is a public health concern. Among 5-year-olds, 16% of Latinos are obese compared with 10% of whites. Obesity disparities between non-Latino white and Latino children increase significantly with age. The purpose of this study is to examine the importance of socioeconomic status (SES), home language, physical activity, and TV watching for explaining obesity disparities between 5-year-old white and Latino children. Also, the long-lasting influence of these four variables is studied by analyzing their impact on obesity as children grew to ages 6, 8, and 10. We used a nationally representative sample drawn from the Early Childhood Longitudinal Study- Kindergarten Cohort (ECLS-K) collected in 1998-99.Ítem Estadísticas del sistema de salud : Colombia frente a OCDE.(Centro de Estudios en Protección Social y Economia de la Salud - PROESA, 2016-09-01) Prada Ríos, Sergio Iván; Salinas, Manuel A.This paper presents comparative statistics on the performance of health systems between Colombia and countries members of the Organisation for Economic Co-operation and Development. The data used is from OECD Health Statistics 2016, a publication that summarizes data for the 35 member countries, those countries in the process of adhesion – Colombia, Latvia, Costa Rica, Lithuania and the Russian Federation, and key partners - Brazil, People´s Republic of China, India, Indonesia and South Africa. We found that in all indicators where data for Colombia is available the country is at least one standard deviation behind the OECD average, but Government and compulsory health insurance schemes (% of current expenditure on health) which is above average.Ítem Medición de gasto de bolsillo en salud usando la Encuesta Nacional de Calidad de Vida de Colombia(Centro de Estudios en Protección Social y Economia de la Salud - PROESA, 2016-03-01) Guerrero Carvajal, RamiroIn 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.Ítem ¿Y usted, cómo lo haría? El Programa de Tuberculosis de Médicos Sin Fronteras en Buenaventuras(Centro de Estudios en Protección Social y Economia de la Salud - PROESA, 2016-01-01) González, Jorge A.There are several NGOs around the world whose main purpose is the private provision of public programs. Their actions are aimed to provide services to vulnerable populations where the government has constitutional responsibility to provide but fails to do so. This document describes this kind of intervention; a program for the drug resistant tuberculosis population in the municipality of Buenaventura, located in the Colombian state Valle del Cauca. The document answers retrospectively to the question: In a context without budget constraints, with people in high economic vulnerability, and amid serious problems of violence, how would you design, operate, and how much would cost a TB program for a multidrug resistant population?Ítem La desagregación de los gastos privados en atención médica en Colombia; Implicaciones políticas(Centro de Estudios en Protección Social y Economia de la Salud - PROESA, 2015-01-01) Chernichovsky, DovEl 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.Ítem Escenarios posibles para el Sistema General de Seguridad Social en Salud (SGSSS)(Centro de Estudios en Protección Social y Economia de la Salud - PROESA, 2014-12-01) Guerrero Carvajal, Ramiro; Prada Ríos, Sergio IvánThis 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.Ítem Una Estimación del Costo y Cambios en el Bienestar de los Colombianos con el Nuevo Plan de Beneficios en Salud.(Centro de Estudios en Protección Social y Economia de la Salud - PROESA, 2013-12-01) Riascos, ÁlvaroEn este artículo se estima el costo esperado del nuevo plan de beneficios en salud. El análisis parte de la base de que al disminuir las barreras para la reclamación de servicios que en la actualidad se consideran por fuera del POS, denominados aquí No POS, habrá una recomposición de la demanda por servicios de salud entre el POS y No POS. La aproximación metodológica utilizada consiste en la estimación de un modelo de elección discreta que con base en las elecciones observadas de reclamaciones y consumo de servicios POS y No POS a nivel individual, permite estimar las preferencias reveladas de los individuos. De esta forma también se puede hacer un análisis de la variación en el bienestar de los individuo antes y despúes de la reforma.Ítem Modelos de contratación, evidencia científica y posibles opciones para Colombia(Centro de Estudios en Protección Social y Economia de la Salud - PROESA, 2013-01-01) Castro, HéctorThis paper summarizes the international evidence on payment modalities for health services and taking into account the specificities of the Colombian context and the regulatory framework of the country (Social Security System in Health-SGSSS) issues some recommendations that can be implemented in the short and medium term by Entidades Promotoras de Salud (Health Promotion Entities). It is found that in Colombia the most popular payment mechanisms are those that have been identified in the literature as worst regarding economic incentives. Given the SGSSS there is ample room to experiment and implement with payment modalities that combine different single mechanisms. This could minimize the risks of each single system and potentiate its advantages.Ítem Case Study: HIV/AIDS in the Context of the Colombian Health Care Reform(Centro de Estudios en Protección Social y Economia de la Salud - PROESA, 2012-07-01) Guerrero Carvajal, RamiroStarting 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.Ítem Diseño y reforma del Plan Obligatorio de Salud en Colombia.(Centro de Estudios en Protección Social y Economia de la Salud - PROESA, 2012-05-01) Guerrero Carvajal, RamiroThe 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.Ítem La sinfonía incompleta: La reforma al Sistema de Salud de Colombia(Centro de Estudios en Protección Social y Economia de la Salud - PROESA, 2012-09-01) Chernichovsky, DovEste documento hace un análisis crítico de la reforma al Sistema de Salud que emprendió Colombia con la entrada en vigor de la Ley 100 de 1993. El documento expone por qué, a pesar un diseño creíble y visionario de modelo, la implementación de la reforma sigue incompleta. El documento propone una serie de cambios que puedan hacer de las instituciones existentes un Sistema de Salud más eficiente y más equitativo que el actual. Las recomendaciones incluyen la integración inteligente de los recursos, la reconsideración del modelo de competencia regulada en áreas marginales y cambios en los entes responsables por la promoción de la salud y la atención preventiva.