Are Any Alternative Models of Primary Health Care Possible in Market Systems?

In Colombia Law 1438 of 2011 opened the possibility of initiating a reform of the social security health system by establishing the legal basis to implement the strategy of Primary Health Care Network within the operation of Integrated Health Services. The same legislation, keeps the fragmented insurance model in the contributory scheme for employers and employees, in the formal and informal sectors of the economy, and subsidies for the poorest.

Colombia has been affected by a social trust crisis among different stakeholders such as public agencies, private and social civil organization. There are financial problems, corruption, a perverse payment system that affects the actions of prevention and health promotion and serious restrictions on access to services that give rise to claims before the court system to defend their rights.

The past legislation was created on structured pluralism principles with many actors seeking for the competition of health services between private and public agencies who concentrated all human, financial and technical resources in therapy and rehabilitation.
These created weaknesses in public health and had consequences at the national, local and regional level. Because of economic reasons this model led to the closing public hospitals and its most important institution; Social Security and Institute of Social Security.

Despite this context, which weakened previous primary care services in the late 70s and 80s, we can mention some attempts of work with doctors, nurses and community workers. Bogota, against the insurance model, leads nowadays the most outstanding experience because of political tools held by politicians and academic agents that have criticized and questioned the governmental system .