Implementation of a new health system in Colombia: is this favourable for health determinants?

The new reforms of health systems in Latin American countries began in the 1990s as part of wider state reforms, promoted by the International Monetary Fund and World Bank. In Colombia, the new system called National Social Security System for Health (Sistema Nacional de Seguridad Social en Salud, SNSSS) was defined by the Law number 100, approved in 1993 by the Congress. Its regulation is under the responsibility of the Ministry of Health and the National Health System Surveillance Institute (Superintendencia Nacional de Salud SNS) that exerts control over the new system structure. Different types of institutions of medical care, with strong privatisation and competitiveness were introduced by the new law. To facilitate the transformation of public hospitals into more competitive institutions, the Ministry of Health transformed them into “State Social Enterprises” (Empresas Sociales del Estado, ESEs), and also created a new type of healthcare institution called “Health Solidarity Enterprises, (Empresas Solidarias de Salud, ESSs) to allow communities to organise their own enterprises to provide health insurance to individuals and families. Both types of institutions have the responsibility to administer the resources provided by the government to finance the health care of the poorest groups under the so called Subsidied Regimen (Regimen Subsidiado). These two types of “state” institutions should compete with private groups and enterprises but without having the experience and organisation of private sector.