Plans health insurance systems: Realities and Prospects, An assessment study

Planes de salud en sistemas de aseguramiento: Realidades y Prospectivas

Objective: explore international experiences in the use of health benefit plans and the status and prospects of these after equalizing health services for the population in Colombia, 2013-2014. Materials and Methods: an assessment study was conducted. Through expert opinion and literature search to compare nine (9) national systems, assurance and mixed to compare. Information on the existence of health coverage plans and approaches and mechanisms used in its construction was sought. Experts discussed the situation in Colombia and the implications of the findings. Eventually became a reconstruction from the perspective of the authors. Results: some systems choose which one positive lists that specify the coverage of the system, while most uses negative lists, which require exclusions, either based on people, pathologies or services. In Colombia, both mechanisms are used simultaneously, however users and system agents are perceived as inappropriate, so it resorts to legal tools, which hamper its implementation, demonstrating tension between individual rights and sustainability and equity of the system. Conclusions: as essential for the effective exercise of the right to health factor is important to ensure a health care plan that enjoys social acceptance, document quality care and sustainable and universal.