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Health Inequality in Colombia

The Relationship between Health Inequality and Economic Welfare of Colombia

The aim of the paper is to discuss health inequality in Colombia. Colombia experiences the widest level of differences, with the capital city facing serious challenges of access to health services, social disparities, and poverty. Health inequality experienced in the country is related to higher rate of unemployment, poor resource distribution, and poverty. Reforms such as the implementation of the health coverage insurance program have expanded health care coverage through a provision of universal health insurance that has enabled the poor and vulnerable people to access health care. The country has also adopted a model that focuses on prevention to improve the health status of the people. Other initiatives include increasing the number of health facilities, medical personnel, and medical expenditure. The model of care has been changed to ensure better use, access, and provision of comprehensive services. The government has also taken initiatives to develop and implement social strategies and public policies to address health inequality issue through tax reforms, increasing access to education and social insurance.

Health inequality is unjust and preventable differences in the health status experienced by people or groups due to their geographic, social, and biological factors. Economic well-being is a family’s or person’s standards of living based mainly on their financial status. The government utilizes income to establish the economic well-being of an individual. Health inequality and economic well-being in Colombia are related. Colombia has the widest level of health inequalities, with its capital Bogota facing serious problems of access to health services, social disparities, and the problem of poverty (Bernal & Cárdenas, 2015). Health inequalities in the country are related to the higher rate of unemployment, poverty, and poor resource distribution. The main aim of the research paper is to understand the relationship between health inequality and the economic well-being in Colombia.

Labor income is the highest contributor of household income in Colombia. The country has the highest unemployment rate in Latin America, which has contributed to inequality since the great number of unemployed has less capital than it can enable them to access health services. Furthermore, the segmented labor market between informal and formal workers has led to the further discrepancies in income. Economic inequality has impacted negatively on access to health. The current system of social security in health provision has proposed quality, efficiency, and equity as the major goal. The income inequality experienced in the country has declined since fifteen years ago even though it remains high by the world standards (Abadia & Oviedo, 2011).

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Income dispersion has originated from the labour market characterized by a broad wage distribution, a pervasive informal sector, and high rates of unemployment. Income distribution has affected access to health care as well as risk factors, resulting in health inequality among citizens. Poverty is among the issues that have led to health disparities. Poor people with low income are unable to access health care due to poor income distribution. However, the Colombian government has put various plans in place to reduce poverty levels in the country. Among the plans is increasing access to education and reducing unemployment. Fair income distribution will ensure that citizens can access health care. The relationship between health inequality and economic well-being is also affected by stability. High inequality is a source of social tension and distributive conflicts. A poor distribution of resources and income has made it impossible for the poor to access health care services. Inadequate stability has undermined the economic growth by discouraging investment in various areas, including health. The Colombian government is at the forefront of ensuring security, and equality in resource distribution is achieved through various plans such as the tax reform and health insurance (Birchenall, 2011).

Health Care System Design

In 1993, the Colombian reforms resulted in the implementation of a social health insurance program that had the goal of expanding the health coverage by providing universal health insurance because the previous scheme had covered only a small percentage of the total Colombian population. It only included the wealthy and employed individuals who worked in the formal economic sector. The poor population accessed health care benefits through harmonizing and subsidizing their demands. All this was done to address the issues of health care inequity. Before the implementation of the reform, the inequality of health care was universal. According to Glassman, Escobar, Giuffrida, and Giedion (2012), most of the medical issues were handled in the wealthiest economic part, accounting for 84.3%/ only, and only a small portion of about 16% was addressed in the poorest area. The mechanism of financing focused on the cross-subsidy of the payments made by people to the social security. Individual, who earned highly, subsidized poor people, while the state contributed an equal amount through budget reserves.

A radical transformation was required for the introduction of health reform into the system. The changes involved increasing the amount contributed to the social health scheme - a benefits package of private and public providers in a controlled competition insurance plan with the hope of expanding the effectiveness of health service delivery. A significant population of Colombians, which is approximately 88.2%, is currently insured. The increase in coverage was arrived at through the expansion from family to individual coverage in the affiliation in the low earning population and contributory scheme via subsidized regime. The increase in the then subsidized scheme from 2003 to 2007 is the reason why the coverage has increased (Ruiz Gómez, Zapata Jaramillo, & Garavito Beltrán, 2013). Evidence on the effect of the Colombian reform on health equity is contradictory and scarce.

Most health reforms in Colombia have concentrated on assessing the progress in the access to financial protection and health service achieved by the low-income population. Additionally, the availability of health services to people with special pathologies like diabetes has been realized. The major censure of the health program is pointed towards the worst socioeconomic status of the low-income population in Colombia. Additionally, the little service accorded to the low-income individuals, ineffective access to health service for the most affected groups, and regressive behavior of spending too much as a result of the copayment system contribute to the criticisms directed at the access of health service (Attanasio, Goldberg, & Pavcnik, 2014).

The achievement of health equity in Colombia, out-of-pocket and quality expenditure by families, justifies the institutional changes and society’s involvement in the implementation of the reforms. The results have been measured on the timeline basis without relating it to the health requirements and the socio-economic status of the population. The outcome in the health equity may be an important and efficient mechanism to assess the results in the health system in Colombia and to instill future policies as soon as the state attains universal medical coverage (Birchenall, 2011).

Bonet (2012) states that apart from the universal health scheme, Colombia has plans to improve its health care program through adopting a model that stresses on the prevention using a policy-based loan amounting to 250 million US dollars borrowed from the Inter-American Development Bank (IDB). The objective of the program is to offer help to the implementation and design of the health system reforms to attain a continuous progress in the health results and ensure the transparency and flow of public utility for health services in Colombia. The emphasis on offering essential care will enhance prevention, diagnosis, and early identification of health complications. These will help individuals to seek medical attention soon, which will generate better outcomes and require less costly medical interventions. However, strengthening the institutions will create significant effectiveness in the administration of health facilities (Glassman et al., 2012). The IDB has offered support to the government of Colombia to ensure that the country achieves sustainable health care system. Additionally, the bank has helped in the laying down of new institutes to assist in the assessment of health and in funding the methodologies and technical support for the improvement of the evaluation processes alongside helping in the designing of the pharmaceutical policy. A primary health care strategy initiated in 2004 aimed at addressing the social determinant of inequalities and the improvement of health care services for the people.

Appendix 1 shows the Colombian’s health care system while Appendix 2 presents a decline in poverty level within the country. The table is an evidence of the huge progress the country has made in reducing poverty levels. However, the rate of poverty and inequality is still high per the international standards. An intersectoral commission created to improve health inequality has a significant role in developing a post-conflict Colombia (Mosquera, Zapata, Lee, Arango, & Varela, 2001).

Healthcare Provisions and Health Inequality

Despite the constraints posed by both political and social instability, Colombia’s health service has taken significant steps forward to an extent of being recognized internationally. According to the World Health Organization (2000), Colombia was ranked number one in Latin America and twenty-second worldwide. Many of the positive scorings are contributed by the facilities and coverage of the infrastructure of causalities. As per the WHO report (2000), the total expenditure in the health sector, including private and public resources, was 6.1% of gross domestic product in 2011. The proportion has reduced in the recent years. The total number of physicians in Colombia is substantial, according to the standards of the region. The World Health Organization report of 2012 revealed that Colombia had enough doctors that could serve the increasing number of citizens. Colombia has about 63,000 doctors (Restrepo & Valencia, 2012). The country had a total of 10.36 physicians per a thousand people (Restrepo & Valencia, 2012). The doctors inhabit more affluent areas and urban parts of Colombia. The notion of universal health attention in Colombia has been in action since 1993. The system has been able to cover 95.72% of the total Colombian population, according to a report published in 2012 by the Ministry of Social Protection and Health. In the early 1980s and 1990s, Colombia’s health care organization was a monopoly run by the government (Bonet, 2012). Employees and employers contributed money to a pool. The finances channeled to the social security system were state sponsored. The state-run social security helped the majority of the people who were poor and who had no option. The rich took the advantage of the private health care in the elite clinics. In 1993, there was the transformation of the public health structure. The subsidized and contributory regime was introduced. The coverage levels have been increasing steadily since 1993, where it was 25%, but in 2002, it was 62% (Restrepo & Valencia, 2012).

The health security and general welfare in Colombia warrants access to the generic essential medicine via the required health plan for the people insured under the contributory regime. Those under subsidized government face certain restrictions when accessing the services. Individuals that are not covered do not benefit from the service because it is specifically meant for the primary medical attention that does not surpass $8,000. There are about 899 health centers and hospitals. Colombia has 53 medical schools, and 15 of them have a hospital. The country has 4,458 health institutions (Glassman et al., 2012).

According to Ruiz Gómez, Zapata Jaramillo, and Garavito Beltrán (2013), the socio- economic status and social contexts are the primary factors supporting the notion of health inequalities in Colombia. The social status influences the quality of the socio-economic variables that function through the biological process to affect morbidity, thereby causing infant and child mortality in the developing nations. High incidences of violence influence negatively the accumulation of education as well as wealth. Migration may also affect the health of children through a change in the social status (Restrepo & Valencia, 2012). Nutrition through diet, breastfeeding, minerals, and proteins is significant for individual’s health irrespective of age. Poor nutrition exposes infants to diseases, making them unable to cope with them (Marmot, 2015). Environmental pollution is also important as, for instance, water and air pollution both in rural and urban areas affect the health of infants. Other cultural malpractices and demographic features like marriage and sex affect the health of a child to some extent. There are cases where one has to be treated differently because of their marital status or even gender. This practice leads to the neglect of some infants. Additionally, maternal biological aspects like parity, age, and birth intervals are perceived as significant since they capture the mindset that children born to older or younger mothers are at high risks of facing death as compared to children born from middle age parents. Therefore, the number of active children and the intervals between births influence the perception of the mortality risks in infants (Hurtado, Kawachi, & Sudarsky, 2011). The Colombian health system is often based on an insurance market with different service providers, public-private fund managers, and service packages of health benefits. The regulated competition scheme of the system, the public and provider combinations of vendors and market approach have created fragmentation and segmentation of health access and challenges in access, especially for the vulnerable groups.

Bogota, the central city of Colombia, has the highest rate of political, economic, cultural and social development in the country with the largest health care network. The country faced serious challenges of social disparities, poverty problems, and access to health care services that increased social and economic inequalities. The government took an initiative to develop and implement social strategies and public policies to address the social effects of such variations through tax reforms. A full range of intervention and range of programs in Bogota and other parts of Colombia such as housing subsidies, economic and nutritional subsidies, building of new nurseries and schools, and employment generation has been initiated to reduce the existing inequality (Mosquera et al., 2001). The health sector in the country has decided to change the model of care to ensure better use, access, and comprehensiveness of the services provided.

Conclusion

Undoubtedly, Colombia has a long way to go if it aspires to reach the Organization for Economic Cooperation and Development (OECD) level of inequality. The achievement is a relevant benchmark and not just an accession requirement. Despite the country facing serious challenges of social disparities, poverty problems, and access to health care services that increased social and economic inequalities, the Colombian government has taken the initiative to develop and implement social strategies and public policies to address the social effects of such variation by increasing access to education, reducing the unemployment rate as well as access to health care provision through social insurance and tax reform.