Adapted from: De Groote T., De Paepe P., & Unger J.-P. (2005). Colombia: In vivo test of health sector privatization in the developing world. International Journal of Health Services, 35(1), pp. 125–41.

Introduction

The reform of the Colombian health sector in 1993 was founded on the internationally promoted paradigm of privatization of health care delivery. Taking into account the lack of empirical evidence for the applicability of this concept to developing countries and the documented experience of failures in other countries, Colombia tried to overcome these problems by a theoretically sound, but complex, model. Some 10 years after the implementation of ‘Law 100,’ a review of the literature shows that the proposed goals of universal coverage and equitable access to high-quality care have not been reached. Despite an explosion in costs and a considerable increase in public and private health expenditure, more than 40% of the population is still not covered by health insurance, and access to health care proves increasingly difficult. Furthermore, key health indicators and disease-control programmes have deteriorated. These findings confirm the results in other LMICs. The authors suggest the explanation lies in the inefficiency of contracting out; the weak economic, technical and political capacity of the Colombian Government for regulation and control; and the absence of real participation of the poor in decision making on (health) policies.

Privatization of health care delivery in developing countries received support from virtually all international aid agencies (European Commission, 2002; World Bank, 1997; World Health Organization, 2000).