In 1993, Colombian health care organization was profoundly changed as a consequence of a parliamentary law called ‘Ley 100’ (the ‘100 Law’) ⁵⁰ , ⁵¹. Based on a radical alteration in the way support for health care is generated and administered, this law aimed, by 2000, to guarantee equal access to health services for the entire population independently of individuals’ financial and social circumstances. According to this law, all active workers pay a standard contribution of 12% of their monthly salary (1/3 of this percentage is usually paid by the employee and 2/3 by the employer); this contribution is administered by private non-governmental decentralized organizations.

It has been reported, however, that poor communication systems, inadequate distribution of health services which are mostly concentrated in urban sectors, a low physician/inhabitant ratio of 1/1350, prohibitive costs of medicines, and a health care organization very much orientated towards cure with scarce preventive strategies have contributed to the disadvantageous situation of the poorest and the rural sectors in society that remain unable to access basic health care⁵² , ⁵³. It has also been suggested that, as a consequence, alternative and indigenous medicines are frequently used by the more disadvantaged social groups.¹⁹

Table 4 shows total health expenditures as percentages of GDP for South American countries in 2001. Colombia is the lowest fourth after Ecuador, Perú and Bolivia.

Table 4: Total health expenditure as a percentage of GDP: countries of South America for 2001

Country	Total health expenditure as % of GDP (2001)
Uruguay	10.9
Argentina	9.5
Suriname	9.4
Paraguay	8.0
Brazil	7.6
Chile	7.0
Venezuela	6.0
Colombia	5.5
Bolivia	5.3
Peru	4.7
Ecuador	4.5

Source: WHO statistics 2000-2002

Table 5 shows the principal sources for public and private health expenditure in the country.

Table 5: Selected national health accounts indicators (2001 estimates)⁵⁴

Value
Indicator
Per capita GDP in international dollars	6,519
Total health expenditure
Total expenditure on health as % of GDP	5.5
Public health expenditure
General Government expenditure on health as % of total expenditure on health	65.7
Per capita government expenditure on health in international dollars	234
Sources of public health expenditure
Social security expenditure on health as % of general government expenditure on health	25.0
Private health expenditure
Private expenditure on health as % of total expenditure on health	34.3
Sources of private health expenditure
Prepaid plans as % of private expenditure on health	34.8
Out-of-pocket expenditure on health as % of private expenditure on health	65.20

Source: WHO statistics 2000-2002

Table 6 shows that, in 2001, Colombia expended 356 Intl $ per inhabitant on health. This figure is the seventh highest amongst eleven South American countries.

Table 6: Total health expenditure capita (Intl $) in countries of South America, 2001

Country	Total health expenditure per capita (Intl $, 2001)
Argentina	1,130
Uruguay	971
Chile	792
Brazil	573
Suriname	398
Venezuela	386
Colombia	356
Paraguay	332
Peru	231
Ecuador	177
Bolivia	177

Source: Source: WHO statistics 2000-2002

In Graph 1, it is shown that there are significantly more physicians than nurses in Colombia, as in most South American countries⁵⁵. Figures for other health professionals relevant to palliative care, such as pharmacists or social workers are scarcely reported.

 

Graph 1. Rate of physicians and nurses per 100,000 population per year in South American countries. Source: The World Health Report 2003, WHO statistics 2002-2003