Table 5 Morphological analysis of the GHSSS to 2033
From: Possible future scenarios of the general health social security system in Colombia for the year 2033
Factors | Dimensions | If you can access, we will provide care for you | Integrated territorial action model | Health for all |
|---|---|---|---|---|
Environment | Demographics | The trend is towards an aging population and a decrease in healthy years of life. | A marked aging trend prevails, the adoption of primary health care contributes to older adults enjoying more healthy years of life. | There is a marked aging trend; the adoption of a preventive health care model keeps sick older adults under control and detects ailments in the healthy ones at an early stage. |
Determinants of health | The Ministry of Health has a seat on the intersectoral commission on health determinants; however, it cannot integrate health actions with the activities carried out in the determinants. | The Ministry of Health has a seat on the intersectoral commission on health determinants. Because of the model’s territorial approach, in some regions, it has integrated the actions carried out in health with the activities carried out in the determinants. | The Ministry of Health coordinates the management of health determinants to articulate health actions with the activities carried out in the determinants. | |
Financial protection | Out-of-pocket and per capita health spending lower than the average for Latin American countries. The sustainability of the system is threatened by the bankruptcy of the APB and the debt among actors. | Out-of-pocket and per capita spending on health is lower than the average for Latin American countries. The sustainability of the system is threatened by debt among stakeholders. | Out-of-pocket and per capita health expenditure better than the average of Latin American countries. Financed by taxes and contributions | |
Technology | GHSSS capabilities | Specialists, physicians, nurses, and the hospital infrastructure concentrate in urban centers, leaving peripheral regions without these services. The health staff is employed through intermediation. | The family health physician is the entry point to the system. The model’s territorial approach triggers a migration of health professionals from urban centers to some peripheral regions. The health staff is employed through intermediation. | The primary health teams based in the territory reach an equitable distribution of human talent and the system’s resources. All health workers are guaranteed decent, stable, and dignified work. |
Health research and ICTs | Low investment in health research and high dependence on vaccines and the number of telemedicine consultations is increasing. | Increased investment in science and technology to lower medicine costs and recover autonomy in vaccines. Increasing number of telemedicine consultations. | A knowledge-intensive system is promoted to access better treatments and devices. Autonomy in the production of vaccines and biologics is recovered. Health is in the cloud, with a single interoperable information system. | |
Health status | Life expectancy close to the average of Latin American countries and NCDs are the leading cause of mortality. | Life expectancy better than the Latin American average, with a moderate increase in the NCD mortality rate. | Life expectancy close to the average of OECD countries, with a low increase in the NCD mortality rate. | |
coverage and access | Insurance is universal, but access to health services has administrative, geographic, regulatory, and supply barriers. | Insurance is universal, but access to health services has administrative barriers to specialist appointments and procedures. | An integrated and comprehensive health network covers the population, with an extramural team based in the territory as an entry point to the system, guaranteeing the right to health regardless of the person’s payment capacity. | |
Health inequities | Health inequalities between the center and the periphery of the country and the different social strata exhibit an upward trend. | The differential approach allows sectors in the periphery to benefit from better infrastructure and more health workers, thus reducing inequities among regions, although inequities among socioeconomic strata persist. | As extramural medical teams are installed in rural areas and in the most vulnerable sectors of the cities, the differences among regions and socioeconomic strata are reduced. | |
Quality of care | Childhood vaccination rate close to the average for Latin American countries and survival rate at five years of age for cancers far below the average for other Latin American countries. | Childhood vaccination rate better than the average for Latin American countries, and survival rate at 5 years for cancers close to OECD countries | Childhood vaccination rate close to the average of OECD countries and survival rate to 5 years for cancers better than the average of Latin American countries. | |
Values | The main value is equality, and the stakeholder with the greatest political power are the APBs. | The main value is equality, and the stakeholder with the greatest political power are the APBs. | The main value is dialog and the stakeholder with the greatest political power is the Ministry of Health. |