Evaluación y aplicación del manejo y definición del concepto de alto costo en salud y la problemática del tratamiento de las enfermedades de alto costo

Abstract

To describe the problems related to high-cost treatments in Colombia since the creation of Law 100 of 1993 and the regulation of the General System of Social Security in Health, taking into account the different actors such as the insurance companies (Contributive and Subsidized Regime), the Service Providing Institutions and the users. The General Social Security Health System (SGSSS), while introducing privatization and the system of competition in insurance, generated a risk dispersion mechanism that protected the insurance companies against their own contingencies and deviations of expenses for the care of affiliates with high-cost illnesses or treatments. This protection is especially necessary when the insurance company, by virtue of a small population pool, cannot respond with its own resources for the totality of the risk for which it is responsible, since the resources it manages are limited. The approach to the treatment of high cost diseases in the SGSSS, since its inception with the regulation of Law 100 of 1993, poses problems in the definition itself, since in some occasions it refers to pathologies, in others to services and in some others to procedures, leaving as a consequence that, Consequently, when providing care and/or services, the weakness of the concept and its inadequate delimitation are evident, a fact that generates differences among the actors of the SGSSS, especially among the insurers (Contributive and Subsidized Regime), the Service Providing Institutions and the users.