Acceso a la atención en salud en Colombia / Access to health care in Colombia

Objetivo Contribuir al conocimiento sobre el acceso a los servicios en Colombia tras la reforma del sistema de salud, exponiendo los principales resultados y vacíos en las investigaciones. Métodos Se realizó una revisión sistemática de la bibliografía, a través de la búsqueda exhaustiva y análisis de artículos originales publicados entre 1994 y 2009. Se incluyeron 27 investigaciones cuantitativas y cualitativas que cumplían los criterios de selección. El análisis se enmarcó en los modelos teóricos de Aday y Andersen y Gold, que diferencian entre acceso potencial y realizado y consideran las características de la población, proveedores y aseguradoras que influyen en la utilización. Resultados Los análisis explicativos de la utilización de los servicios de salud a partir de modelos de determinantes resultan escasos y parciales (limitados a áreas geográficas, patologías o colectivos específicos). Pocos estudios profundizan en factores de contexto -políticas y características de proveedores y aseguradoras- o en la perspectiva de los actores sobre los factores que influyen en el acceso. Los estudios no parecen indicar un aumento del acceso realizado -salvo en el régimen subsidiado- y, en cambio, señalan la existencia de importantes barreras relacionadas con factores poblacionales (aseguramiento, renta y educación) y características de los servicios (accesibilidad geográfica, organizativas y calidad). Conclusiones La revisión muestra limitaciones importantes en el análisis del acceso en Colombia que indican la necesidad de reorientar la evaluación hacia el acceso realizado, e incorporar variables de contexto y la perspectiva de los actores para comprender mejor el impacto de la reforma en el uso de servicios.

Objectives Contributing towards improving knowledge about access to health services in Colombia following health-sector reform, highlighting the main results and gaps in research. Methods Original papers were systematically reviewed through a comprehensive search and analysis of original papers published between 1994 and 2009. After selection criteria had been applied, 27 papers were included in the review. Analysis was based on Aday Aday & Andersen and Gold's theoretical frameworks, distinguishing between potential and actual healthcare access and considering the characteristics of the population, health services and insurers influencing service use. Results There was little explanatory analysis of service use applying determinant models; this was also partial (limited to geographical areas, diseases or specific groups). Likewise, only a few studies analysed contextual factors influencing service use (health policies and health providers and insures) or social actors' perspectives. The available studies did not seem to indicate increased actual access (except for subsidised system users) but, on the contrary the existence of barriers relating to population (insurance coverage, income and education) and health service factors (geographic and organizational accessibility and quality of care). Conclusions This review led to identifying important limitations in the analysis of healthcare access in Colombia and highlighted the need for further research on actual access and the better incorporation of context variables and actors perspectives in understanding the impact of reform on health service use.

[Access to health care in Colombia]. / Acceso a la atención en salud en Colombia.

OBJECTIVES: Contributing towards improving knowledge about access to health services in Colombia following health-sector reform, highlighting the main results and gaps in research. METHODS: Original papers were systematically reviewed through a comprehensive search and analysis of original papers published between 1994 and 2009. After selection criteria had been applied, 27 papers were included in the review. Analysis was based on Aday Aday & Andersen and Gold's theoretical frameworks, distinguishing between potential and actual healthcare access and considering the characteristics of the population, health services and insurers influencing service use. RESULTS: There was little explanatory analysis of service use applying determinant models; this was also partial (limited to geographical areas, diseases or specific groups). Likewise, only a few studies analysed contextual factors influencing service use (health policies and health providers and insures) or social actors' perspectives. The available studies did not seem to indicate increased actual access (except for subsidised system users) but, on the contrary the existence of barriers relating to population (insurance coverage, income and education) and health service factors (geographic and organizational accessibility and quality of care). CONCLUSIONS: This review led to identifying important limitations in the analysis of healthcare access in Colombia and highlighted the need for further research on actual access and the better incorporation of context variables and actors perspectives in understanding the impact of reform on health service use.

[Health-related needs of the displaced population due to armed conflict in Bogotá]. / Necesidades en salud de la población desplazada por conflicto armado en Bogotá.

BACKGROUND: The displacement of populations as the result of an armed conflict generally entails a worsening of the living and health conditions of those undergoing such a displacement. This paper is aimed at analyzing the health-related needs perceived by men and women displaced by the armed conflict and their main strategies to address those needs. METHODS: A qualitative study was carried out by means of semi-structured individual interviews to 31 displaced men and women in the transition stage. A narrative analysis of the contents was conducted, segmenting the information by age and sex. The area under study was made up of five localities in the city of Bogotá. RESULTS: The negative effects on their mental health and psychosocial stability, access to food and, to a lesser degree, gastrointestinal and respiratory disorders, are the main health problems reported by both groups of informants. The difficulty of accessing health care services comes up as an added problem. The precarious economic situation underlies the health care-related needs and problems. To solve their health problems, in addition to the health care services, they employ other strategies within their reach. Expressed needs are coherent with the problems perceived. Some differences between women and men and age groups were observed concerning the definition of the problems and employed strategies. CONCLUSION: In the health field, actions are required in order to improve their access to services in addition to specific strategies for the psychosocial rehabilitation of the displaced population which take into account the differences existing within this group.

Necesidades en salud de la población desplazada por conflicto armado en bogotá / Health-Related Needs of the displaced population due to armed conflict in Bogota

Fundamentos: El desplazamiento de poblaciones como consecuencia de un conflicto armado, conlleva generalmente un deterioro en las condiciones de vida y de la salud de quienes lo padecen. El objetivo de éste artículo es analizar las necesidades en salud percibidas por hombres y mujeres desplazados por el conflicto armado y sus principales estrategias de resolución. Métodos: Se realizó una investigación cualitativa mediante entrevistas individuales semi-estructuradas a 31 personas desplazadas en fase de transición. Se hizo un análisis narrativo de contenido, segmentando la información por edad y sexo. El área de estudio estaba constituida por cinco localidades de la ciudad de Bogotá. Resultados: El compromiso de la salud mental y de la estabilidad psicosocial, los problemas con la alimentación y en menor proporción las afecciones gastrointestinales y respiratorias son los principales problemas de salud referidos por ambos grupos de informantes. La dificultad de acceso a los servicios de salud emerge como problema adicional. La precaria situación económica subyace a los problemas y a las necesidades de atención en salud. Para la solución de los problemas de salud, además de los servicios de salud, las personas desplazadas emplean otras estrategias a su alcance. Las necesidades expresadas son coherentes con los problemas percibidos. Se observan algunas diferencias en la apreciación de los problemas y en las estrategias de solución, entre hombres y mujeres y entre grupos de edad. Conclusión: En el ámbito de la salud, se requieren acciones que permitan mejorar el acceso a los servicios, así como estrategias específicas para la rehabilitación psicosocial de la población desplazada que tengan en cuenta las diferencias en el interior del colectivo (AU)

Background: The displacement of populations as the result of an armed conflict generally entails a worsening of the living and health conditions of those undergoing such a displacement. This paper is aimed at analyzing the health-related needs perceived by men and women displaced by the armed conflict and their main strategies to address those needs. Methods: A qualitative study was carried out by means of semi-structured individual interviews to 31 displaced men and women in the transition stage. A narrative analysis of the contents was conducted, segmenting the information by age and sex. The area under study was made up of five localities in the city of Bogotá. Results: The negative effects on their mental health and psychosocial stability, access to food and, to a lesser degree, gastrointestinal and respiratory disorders, are the main health problems reported by both groups of informants. The difficulty of accessing health care services comes up as an added problem. The precarious economic situation underlies the health care-related needs and problems. To solve their health problems, in addition to the health care services, they employ other strategies within their reach. Expressed needs are coherent with the problems perceived. Some differences between women and men and age groups were observed concerning the definition of the problems and employed strategies. Conclusion: In the health field, actions are required in order to improve their access to services in addition to specific strategies for the psychosocial rehabilitation of the displaced population which take into account the differences existing within this group (AU)