The Consequences of Neoliberalism COLOMBIA: IN VIVO TEST OF HEALTH SECTOR PRIVATIZATION IN THE DEVELOPINGWORLD

The reform of the Colombian health sector in 1993 was founded on the internationally advocated paradigm of privatization of health care delivery. Taking into account the lack of empirical evidence for the applicability of this concept to developing countries and the documented experience of failures in other countries, Colombia tried to overcome these problems by a theoretically sound, although complicated, model. Some ten years after the implementation of “Law 100, ” a review of the literature shows that the proposed goals of universal coverage and equitable access to high-quality care have not been reached. Despite an explosion in costs and a considerable increase in public and private health expenditure, more than 40 percent of the population is still not covered by health insurance, and access to health care proves uncreasingly difficult. Furthermore, key health indicators and disease control programs have deteriorated. These findings confirm the results in other middle- and low-income countries. The authors suggest the explan-ation lies in the inefficiency of contracting-out, the weak economic, technical, and political capacity of the Colombian government for regulation and control, and the absence of real participation of the poor in decision-making on (health) policies. Privatization of health care delivery in developing countries received support from virtually all international aid agencies (1–3). Expressions such as “stewardship” and “steering rather than rowing, ” used in policy documents on the global agenda for health sector reform from the World Bank and the World Health Organization (WHO) (4, 5), allude to the desired characteristics of this new public-private partnership. The recommendation that clinical care delivery be contracted out t