Can an old dream come true? A health system that meets patients and doctors expectations

Rodrigo Nel Córdoba R, MD (1)

(1) Psychiatrist. President of the Asociación Colombiana de Sociedades Científicas (Colombian Association of Scientific Societies). Bogotá, Colombia.

Received: 15-09-10 Accepted: 15-10-10

Law 100 of 1993 has important supporters as well as notable detractors. During its genesis people envisioned a real health system based on universal principles such as solidarity, equality, and the possibility of providing access for everyone to the new system. It would help establish a model that could be a solution to the problems of the epoch, so that people would gain a right that from that time on would be seen as fundamental because of its direct connection to the right to life. Nevertheless, representative voices from important sectors of society now tell us that the health care system has fallen into the hands of intermediaries and business people whose sole preoccupation is money, money, money. In other words, they say the health care system has fallen into the hands of people who care little, if at all, about the well being of our patients.

It seems that this vision has been fulfilled more than has the original one. Despite the achievements in terms of increased coverage, health care is passing through its most difficult moments. Most importantly this difficult moment has resulted from the disproportionate growth of a few entities in charge of providing health care. Initially they aimed to prevent disease and illness and develop integrated treatment programs, but that flower bloomed and faded in one day, to be replaced with the reality of organizations dedicated only to generating geometric growth of their own capital.

At the beginning of this year, the Executive branch of the government greeted us with some decrees declaring a very inopportune social emergency in an effort to put some order into the system. The orientation of those decrees was focused upon correcting problems through balancing out the grave financial disequilibria in the system by establishing a series of regulations controlling the medical practice of physicians and other health care professionals. These regulations were replete with explicit threats of ethical and economic sanctions to be levied against those who did not maintain the "financial equilibrium" of the system. In response an enormous movement of this country’s physicians, members of other health care professions, patients and civil society arose. That movement considered the decrees to be a serious attack on the rights of the Colombian people. Thankfully, the Constitutional Court’s decision made it clear that this movement’s demands were just and necessary.

Months before the Constitutional Court had made it clear that health is a fundamental right, which cannot be interfered with. In virtue of that fact every Colombian must have access to health care. Organizations of physicians and health care professionals have understood that there will not be another opportunity and have unity together to form a powerful and unity medical movement including the Academia Nacional de Medicina (National Academy of Medicine), Asmedas (Asociación Médica Sindical Colombiana- Medical Union Association of Colombia), Federación Médica (Medical Federation), Colegio Médico Colombiano (Colombian Medical College), ANIR (Asociación Nacional de Internos y Residentes – National Association of Interns and Residents), ACOME (Asociación Colombiana Medica Estudiantil – Colombian Association of Medical Students) and the Scientific Associations. We have united around the collective idea of defending the basic precepts and essential reasons of our professions. These include medical autonomy, rigorous and up-to-date training for all of our colleagues, and social responsibility which obliges us to regulate ourselves as an essential part of our professions. Pat of this is the clear premise that it is necessary to improve working conditions and economic benefits for all of our professions.

Now, in the Congress of the Republic the Executive branch has announced an ordinary bill which combines 11 individual projects to "reform" the Colombian health care system. After analyzing this bill we have found that it in no way reflects the position of the health care professionals united in the Unidad Profesional (Professional Unity). For this reason we are conscious of our historic responsibility to search for and find a real health care reform which is in favor of Colombians fundamental right to health care. Consequently, we withdraw any support or acquiescence we may have previously offered to the aforementioned bill.