Abstract

GARCIA U, JUAN CARLOS  and  AGUDELO C, CARLOS A. Some relationships between finances, payment systems, and provision of health services in hospitals of the Bogotá District Health Service. Rev. salud pública [online]. 2002, vol.4, n.2, pp.128-148. ISSN 0124-0064.

The public hospitals located to the Southwest of Bogotá received their financial resources during the period 1996-2000 mainly for providing health care to people without payment capacity, which belong to either the subsidized regime or to the unaffiliated one. The District financial health fund payed for these services. For the unaffiliated it used three forms of payment: historical budget, payment for activities accompanied by fund transfers and prospective payment for final activities, linked to performance contracts. In the subsidized regime payment was done in two main forms: training for activities of primary health care, which shows a decreasing trend, and payments for events which has passed from sets of activities to individual activities in the three levels of health care. No clear relationships were found between the forms of payment, on one side, and provision of health services and hospital financing, on the other. The changes in the forms of payment introduced since 1999 halted the increase in the income of hospitals, considerably reduced investment and, although the payment of staff remained relatively constant, the proportion of these payments to the general expenses increased. These reductions did not reflect upon the provision of health services, which has increased continuously and constantly. The so-called hospital crisis in Bogotá may well be an effect of the payers and the fees rather than of the hospitals.

Keywords : Social security; health care system; capitation fee.

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