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Tuberculosis control and managed competition in Colombia.
Maria Patricia Arbelaez1, Marta Beatriz Gaviria, Alvaro Franco
1Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia. mpam@guajiros.udea.edu.co
The International Journal of Health Planning and Management
|February 3, 2005
Summary
Colombia's Health Sector Reform, a managed competition model, negatively impacted tuberculosis (TB) control. Key indicators like vaccination, case finding, and cure rates declined, disproportionately affecting vulnerable populations.
Area of Science:
- Public Health
- Health Policy
- Epidemiology
Background:
- Law 100 introduced the Health Sector Reform in Colombia, establishing a managed competition model.
- The reform aimed to improve healthcare delivery but its impact on specific disease control programs requires evaluation.
Purpose of the Study:
- To assess the effects of Colombia's managed competition model on tuberculosis (TB) control outputs and outcomes.
- To identify specific areas of TB control performance that were affected by the health sector reform.
Main Methods:
- Analysis of secondary data on key TB control indicators.
- Qualitative data collection through 25 interviews with key informants from public and private health institutions and directorates.
Main Results:
- Deterioration in TB control performance, including decreased BCG vaccination, reduced case finding and contact identification, low cure rates, and increased loss to follow-up.
- Observed fragmentation and discontinuity in technical processes, lack of coordination, and disintegration of the health information system.
- Adverse effects attributed to the dominance of economic rationality and weak state stewardship within the managed competition framework.
Conclusions:
- The managed competition model in Colombia has had detrimental effects on TB control.
- Recommendations include restructuring the public health component of the reform, strengthening state public health capacity, and improving the health information system for public health goals.