Accesibilidad a los servicios de la salud en Colombia
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Fecha
2026
Autores
Rodríguez González, Darling Eduardo
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Ediciones Universidad Simón Bolívar
Facultad de Administración y Negocios
Facultad de Administración y Negocios
Resumen
Una de las reformas de los sistemas de salud que se han promovido en Latinoamérica con el objetivo de mejorar el acceso a la atención es el modelo de competencia regulada (1), caracterizado por la introducción de un mercado regulado en el que aseguradoras compiten por la afiliación de la población (2-4). Colombia fue uno de los primeros países de la región en el acceso a la salud en Colombia es un derecho fundamental, pero enfrenta desigualdades significativas.
La Ley 100 de 1993 y la Ley Estatutaria 1751 de 2015 han buscado garantizar cobertura universal. Existen dos regímenes: contributivo y subsidiado, pero la calidad y el acceso son desiguales. Factores como la corrupción, la informalidad laboral y las barreras geográficas limitan el acceso. (Ministerio de Salud, 1994)
Se proponen reformas para mejorar la atención primaria, la transparencia y la dignificación del personal de salud. A pesar de que el acceso a la atención es una de las principales preocupaciones de las políticas sanitarias, se trata de un concepto mal definido, que se confunde con términos como accesibilidad, disponibilidad o búsqueda de atención (6,7). Se observan dos tendencias: aquellos autores que definen el acceso como el ajuste entre las características de los servicios y de la población (6-8) y los que lo equiparan con la utilización de los servicios (9,10). Dentro de este enfoque, una de las propuestas teóricas más utilizada es la desarrollada por Aday y Andersen (10,11), que distingue entre acceso realizado - utilización efectiva de servicios -, y potencial - factores que predisponen y capacitan el uso de servicios.
Entre los pocos marcos teóricos de acceso adaptados al modelo de competencia regulada destaca el desarrollado por Gold (12), La reforma del sistema de salud colombiano ha sido un proceso largo y complejo (13), que ha dado lugar a numerosos análisis. En el ámbito del acceso, la discusión se ha centrado principalmente en la extensión de la cobertura de la afiliación al seguro (13-15), sin que existan revisiones sistemáticas de la bibliografía disponible sobre el tema.
One of the health system reforms promoted in Latin America to improve access to care is the regulated competition model (1), characterized by the introduction of a regulated market in which insurers compete for enrollment (2-4). Colombia was one of the first countries in the region to implement this model. Access to health in Colombia is a fundamental right, but it faces significant inequalities. Law 100 of 1993 and Statutory Law 1751 of 2015 have sought to guarantee universal coverage. There are two systems: contributory and subsidized, but quality and access are unequal. Factors such as corruption, informal employment, and geographical barriers limit access. Reforms are proposed to improve primary care, transparency, and the working conditions of healthcare personnel. Although access to care is a major concern in health policy, it remains a poorly defined concept, often confused with terms such as accessibility, availability, or seeking care (6,7). Two trends are observed: those authors who define access as the fit between the characteristics of services and the population (6-8) and those who equate it with the utilization of services (9,10). Within this approach, one of the most widely used theoretical proposals is that developed by Aday and Andersen (10,11), which distinguishes between realized access—the effective use of services—and potential access—factors that predispose and enable the use of services. Among the few theoretical frameworks for access adapted to the regulated competition model, the one developed by Gold (12) stands out. The reform of the Colombian health system has been a long and complex process (13), which has given rise to numerous analyses. In the area of access, the discussion has focused mainly on the extension of insurance affiliation coverage(13-15), without any systematic reviews of the available literature on the subject.
One of the health system reforms promoted in Latin America to improve access to care is the regulated competition model (1), characterized by the introduction of a regulated market in which insurers compete for enrollment (2-4). Colombia was one of the first countries in the region to implement this model. Access to health in Colombia is a fundamental right, but it faces significant inequalities. Law 100 of 1993 and Statutory Law 1751 of 2015 have sought to guarantee universal coverage. There are two systems: contributory and subsidized, but quality and access are unequal. Factors such as corruption, informal employment, and geographical barriers limit access. Reforms are proposed to improve primary care, transparency, and the working conditions of healthcare personnel. Although access to care is a major concern in health policy, it remains a poorly defined concept, often confused with terms such as accessibility, availability, or seeking care (6,7). Two trends are observed: those authors who define access as the fit between the characteristics of services and the population (6-8) and those who equate it with the utilization of services (9,10). Within this approach, one of the most widely used theoretical proposals is that developed by Aday and Andersen (10,11), which distinguishes between realized access—the effective use of services—and potential access—factors that predispose and enable the use of services. Among the few theoretical frameworks for access adapted to the regulated competition model, the one developed by Gold (12) stands out. The reform of the Colombian health system has been a long and complex process (13), which has given rise to numerous analyses. In the area of access, the discussion has focused mainly on the extension of insurance affiliation coverage(13-15), without any systematic reviews of the available literature on the subject.
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Palabras clave
Cobertura en salud, Atención sanitaria, Seguridad social, Servicios de salud, Gestión en salud, Calidad del sistema de salud
