Structuring Pluralism in Health Services. The Colombian Experience

Abstract

During the nineties, the fever of Health Reform has spread all over Latin America. Most countries of the Region started to discuss options for their reforms. So far, few countries have advanced much in their decisions. The paper describes one of the exceptions. Colombia enacted a tropical version of a Managed Competition Act in 1993. During the last 1,000 days the competitive environment created by the new rules of the game allowed the extension of insurance coverage to almost 8 million people and the mobilization of new resources for more than 1% of GNP. The paper describes the main characteristics of the Reform, emphasizing the difficulties of technical design and political economy during the phase of implementation. Many interesting lessons (positive and negative) for other developing countries are derived from this policy experiment.