Salud Pblica, Estado y salud

A reforma de sade na Colmbia no final do sculo XX: uma abordagem histrico a partir da anlise scio-polticoJuan Carlos Eslava C.Profesor asistenteDepartamento de Salud PblicaFacultad de MedicinaUniversidad Nacional de Colombia

1Abordagem histrico e anlise scio-polticoComo uma obra histrica interessa para explicar processos de mudana social a mdio prazo, como uma anlise sociopoltica tenta aliviar a dinmica do confronto poltica entre os atores sociais

A reforma da sade estava relacionado com o ajuste macroeconmico, a reduo do tamanho e papel do Estado e do mercado de desregulamentao ocorreu nos pases da regio, entre 80 e 90Reorganizao relaesEstado-Mercado3Poblacin total : 45.509.584 habitantesPoblacin menor 15 aos: 28,6%Poblacin mayor 60 aos: 9,8%Tasa global de fecundidad: 2,35Tasa de mortalidad infantil x 1000: 17,1Esperanza de vida al nacer: 75 aosEsperanza de vida hombres: 72Esperanza de vida mujeres: 78

PIB per capita $US: 5.142Coeficiente Gini: 0,59Tasa de desempleo: 11,8Gasto nacional en salud como proporcin del PIB: 5,19

ORGANIZACION TERRITORIAL: DEPARTAMENTOS = 32 MUNICIPIOS = 1080 DISTRITOS ESPECIALES = 4TERRITORIOS INDIGENAS

4Reformas de sade na Colmbia no sculo XXIncio do processo de construo no sector da sade (1886-1930) A construo fragmentada do setor de sade (1930- 1975) Consolidacin estructura sanitaria estatal (1930-60)Creacin de los seguros sociales (1945-46)De la integracin a la coordinacin (1962-1966)De la coordinacin a la convivencia de sub-sectores: asistencia pblica y seguridad social (1966-1975)A reforma da dcada de 70 (a formao do SNS) A reforma da dcada de 90 (a formao do SGSS)5

1991-1994De um sistema nacional para um sistema de seguro

El SNS de 1975

Momento poltico especial: nova Constituio

Assembleia Nacional ConstituinteY LA SEGURIDAD SOCIAL?

Discusso sobre Segurana Social aps o ANCMOMENTOSPROCESOS1 finales de 1991 y comienzos de 1992Comisin transitoriaDebates de diversos actores socialesProyecto del Gobierno de reforma pensional2 segunda mitad de 1992El gobierno reformula su propuesta e incluye el tema de la salud (propuesta de creacin de subsidios)3 ao 1993Fuerte discusin parlamentariaPromulgacin de la Ley 100 (diciembre).Discusso sobre Segurana SocialMin-Salud (AD-M19)DNPISS

13En esta polaridad cabe resaltar como protagonistas: el DNP y el ISS.Mapa de actores en el debate de proyectos de reforma (1991-1993)ACTORPOSICINDNP, Min Hacienda, Min TrabajoPL 155/92: fondos privados de pensiones para flexibilizacin laboral (Ley 50/90)Instituto de Seguros SocialesConservar ISS, aumentar cotizacin, separar salud, pensiones y RPMin Salud (AD-M19)Proyecto de SESANA de administracin pblicaSindicatos (CUT)PL 254/92: nuevos sistema integral de seguridad social (ampliada)EmpresariosPrivatizar con modelo chileno sin aumentar cotizacionesGrupo del Partido ConservadorIncluir salud en la reforma, separar pensiones y avanzar con sistema de seguros privadosACEMI (medicina prepagada)Privatizar con modelo chileno dual (ISAPRES, FONASA)ASMEDAS (MD sindicalizados)Conservar ISS, aumentar contratacin privada.ASCOFAMEEficiencia del ISS, aumentar contratacin con privadosSindicatos trab. saludSistema pblico Incorporando al ISS con red pblicaIndgenas y afrodescendientesRgimen especial segn etnias y culturasParlamentarios de AD-M19Sistema nico de aseguramientoGrupo HatograndeAseguramiento, mercado regulado, pblico-privado, subsidio a la demanda14

O "pluralismo estruturado": teorias neoclssicas e neo-institucionalistas para reformas da sade na Amrica Latina

Bienes privados:Servicios de atencin de enfermedadesBienes pblicos:Acciones frente a problemas con altas externalidades (SP)Mercado regulado de aseguramientoEstado descentralizadoSubsidio a la demanda focalizadoEleccin racionalPrincipal-agente delegadaCompetencia reguladaIncorporacin de pobres al mercado por asistencia pblicaConsumidor informadoOs fins da Lei 100/93Instaurar el aseguramiento como esquema general (ampliacin de coberturas).Especializacin de funciones institucionales Libre eleccinIncorporacin del sector privadoFomentar la competenciaCrear mecanismos de solidaridadCrear mecanismos de control de costosGarantizar un Plan Integral de Salud (paquete de servicios)

PALACIO DE JUSTICIA

Alonso Gmez Duque

Antonio Galn SarmientoMara Teresa Forero de Saade

Gobierno Pastrana

Virgilio GlvisSara OrdoezGabriel E Rivero

Colombia: Gasto en Salud como porcentaje del PIB

*Gasto pblico en cuentas nacionales incluye ISS y otras entidades pblicas de seguridad socialTomado de Martnez F. Evaluacin del SGSSS

Novo contexto poltico

Insatisfao e Crises

EMERGENCIA SOCIAL2010Ajustes da poltica

OBRIGADO33Grfico810000006732281199329395014100000070256271994298235231000000795016748009162479054810000009908873.67536075598177422405150.3246392100000012049672.0011941702669019987730.9988059100000012399638.9336941852706118900116.0663059100000012885801.0107323928396618419250.9892677119989612590389.1381313951056619020534.8618687

Otros SistemasAfiliados ContributivoAfiliados SubsidiadoSin coberturaCobertura Seguridad Social Total 1993-2000

Circular2Circular 2 e Informes al Congreso1995199619971998ISS9,319,6549,255,2879,255,28710,023,634Otras pblicas485,504524,890726,499958,474Adaptadass.ds.d342,739342,739EPS Privadas1,029,6473,585,9784,446,7094,563,360Total10,834,80513,366,15514,771,23415,888,207Poblacin total38,541,63139,295,79840,064,09340,826,816Porcentaje28.1%34.0%36.9%38.9%199619971998ISS1515151Otras pblicas1029647EPS PrivadasTotalPoblacin totalPorcentajeCajanal329,797366880448396664154Caprecom101,815101814216035183538Convida53,892501864758773012Risaralda60101390026352Caldas058111418485504524890726499958474EPSAFILIADOS%%CON ISSSIN ISS001 SALUD COLMENA E.P.S. S.A.219,0492.02%14.46%219,049002 SALUD TOTAL S.A. E.P.S.27,5870.25%1.82%27,587003 CAFESALUD E.P.S. S.A.72,0430.66%4.75%72,043004 BONSALUD S.A. E.P.S.65,7800.61%4.34%65,780005 E.P.S. SANITAS S.A.71,3980.66%4.71%71,398006 I.S.S. E.P.S.9,319,65486.02%69,368007 UNIMEC E.P.S. S.A.69,3680.64%4.58%63,342008 COMPENSAR E.P.S.63,3420.58%4.18%21,068009 E.P.S COMFENALCO ANTIOQUIA21,0680.19%1.39%199,701010 SUSALUD E.P.S.199,7011.84%13.18%8,534011 COLSEGUROS E.P.S.8,5340.08%0.56%9,877012 COMFENALCO VALLE E.P.S.9,8770.09%0.65%113,118013 E.P.S. SALUDCOOP113,1181.04%7.47%5,929014 HUMANA VIVIR S.S. E.P.S.5,9290.05%0.39%6,740015 SERVIMED. COLPATRIA E.P.S.6,7400.06%0.44%17,954016 COOMEVA E.P.S. S.A.17,9540.17%1.18%51,408017 E.P.S. FAMISANAR LTDA.51,4080.47%3.39%1,022,896018 E.P.S - S.O.S. S.A.00.00%0.00%019 E.P.S. RISARALDA LTDA.00.00%0.00%020 CAPRECOM E.P.S.101,8150.94%6.72%021 CORPORANONIMAS E.P.S.1,9910.02%0.13%022 E.P.S. CONVIDA53,8920.50%3.56%023 CRUZ BLANCA E.P.S. S.A.00.00%0.00%024 CAJANAL E.P.S.329,7973.04%21.77%025 CAPRESOCA E.P.S.4,7600.04%0.31%026 SOLSALUD E.P.S. S.A.00.00%0.00%TOTALES10,834,805100.00%100.00%TOTAL SIN I.S.S.1,515,15113.98%

Hoja119931994199519961997199819992000EPS Privadas667,7901,839,1953,121,4304,040,6945,382,6296,888,501ISS6,072,6736,356,0196,612,7697,067,3417,841,9807,272,6836,439,5224,685,734Otras EPS Pblicas479,608479,608479,608692,421776,346776,346773,553763,707E. Adaptadas180,000190,000190,000309,916309,916309,916290,097252,448Rgimen Contributivo Incremento anual de afiliados6,732,2817,025,6277,950,1679,908,87412,049,67212,399,63912,885,80112,590,3891994199519961997199819992000Incremento4.36%13.16%24.64%21.60%2.90%3.92%-2.29%Porcentaje4.36%13.16%24.64%21.60%2.90%3.92%-2.29%19931994199519961997199819992000EPS Privadas667,7901,839,1953,121,4304,040,6945,382,6296,888,501ISS6,072,6736,356,0196,612,7697,067,3417,841,9807,272,6836,439,5224,685,734Otras EPS Pblicas479,608479,608479,608692,421776,346776,346773,553763,707E. Adaptadas180,000190,000190,000309,916309,916309,916290,097252,4486,732,2817,025,6277,950,1679,908,87412,049,67212,399,63912,885,80112,590,389Total poblacin37,127,29537,849,15038,541,63139,295,79840,064,09340,826,81641,589,01842,321,38619931994199519961997199819992000EPS Privadas0.00%0.00%1.73%4.68%7.79%9.90%12.94%16.28%ISS16.36%16.79%17.16%17.98%19.57%17.81%15.48%11.07%Otras EPS Pblicas1.29%1.27%1.24%1.76%1.94%1.90%1.86%1.80%E. Adaptadas0.48%0.50%0.49%0.79%0.77%0.76%0.70%0.60%Cobertura total18.13%18.56%20.63%25.22%30.08%30.37%30.98%29.75%Total poblacin37,127,29537,849,15038,541,63139,295,79840,064,09340,826,81641,589,01842,321,386U de Antioquia EPS pblicas19951996199756910,4626,404133,638174,592243,37602,4752,70331,22041,55947,587314,181458,043543,95005,29012,0540012,808007460058100643479,608692,421870,852Adaptadas 98Compensacin196,211No compensanUIS3627Afiliados Entidades Adaptadas 1998-2000Ucauca3072199819992000Ucaldas2492Adaptadas que compensan233,922214,103176,454Caja Cali18597Adaptadas que no compensan759947599475994Univalle7911Total309,916290,097252,448UCrdoba2754UNario2022EAAB16798Unal1872175994272,205

Hoja1

ISSOtras EPS PblicasE. AdaptadasEPS PrivadasCobertura Rgimen Contributivo 1993-1998

Hoja2

EPS PrivadasISSOtras EPS PblicasE. AdaptadasaosAfiliacin Real Rgimen Contributivo. Tendencias por tipo de EPS 1993-2000

Hoja3

PorcentajeaosIncremento real de afiliados Rgimen Contributivo 1994-2000

Hoja4

ISSOtras EPS PblicasE. AdaptadasEPS PrivadasCobertura Rgimen Contributivo como porcentaje de la poblacin total 1993-2000

Hoja54,800,916.005,981,774.007,026,690.008,527,061.009,283,966.00Rgimen Subsidiado Incremento anual de afiliados1994199519961997199819992000199519961997199819992000Afiliados04,800,9165,981,7747,026,6908,527,0619,283,9669,510,566Porcentaje25%17%21%9%2%Incremento24.60%17.47%21.35%8.88%2.44%0.8333330.18180.076901994199519961997199819992000Afiliados04,800,9165,981,7747,026,6908,527,0619,283,9669,510,566Poblacin37,849,15038,541,63139,295,79840,064,09340,826,81641,589,01842,321,386Porcentaje0.00%12.46%15.22%17.54%20.89%22.32%22.47%1994199519961997199819992000Porcentaje00.12456442230.15222426580.17538622430.20885931930.22323119050.2247224606020406080100021.51.33333333331.250.50.33333330.251020304050607080901000.50.33333330.250.20.16666660.14280.1250.1111196048020937943550668386610411471046133314199820002093794EPS35989553550668ESS32317053866104CCF169640120937941547801852706195105661486001696401

Hoja5

AfiliadosAfiliados Rgimen Subsidiado

Hoja6

PorcentajeAfiliados del Rgimen Subsidiado en porcentaje sobre la poblacin total 1994-2000

Hoja8

PorcentajeIncremento anual de Afiliados Rgimen Subsidiado

Hoja7

EPSESSCCFParticipacin de los tres tipos de Administradoras del Rgimen Subsidiado 1998 - 2000

1,9931,9941,9951,9961,9971,9981,9992,000Afiliados Subsidiado4,800,9165,981,7747,026,6908,527,0619,283,9669,510,566Afiliados Contributivo6,732,2817,025,6277,950,1679,908,87412,049,67212,399,63912,885,80112,590,389Otros Sistemas1,000,0001,000,0001,000,0001,000,0001,000,0001,000,0001,000,0001,199,896Sin cobertura29,395,01429,823,52324,790,54822,405,15019,987,73118,900,11618,419,25119,020,535Total poblacin37,127,29537,849,15038,541,63139,295,79840,064,09340,826,81641,589,01842,321,386773228180256271375108316890647.675360820076362.001194121926699.933694123169767.010732323300851.138131319931994199519961997199819992000Afiliados Subsidiado480091659817747026690852706192839669510566Afiliados Contributivo6732281702562779501679908873.6753607512049672.001194112399638.933694112885801.010732312590389.1381313Otros Sistemas1000000100000010000001000000100000010000001,000,0001,199,896Sin cobertura29101535294933902445916521792358193098611836581541,589,01842,321,386Total poblacin371272953784915038541631392957984006409340826816415890184232138619931994199519961997199819992000Afiliados Subsidiado0.00%0.00%12.46%15.22%17.54%20.89%22.32%22.47%Afiliados Contributivo18.13%18.56%20.63%25.22%30.08%30.37%30.98%29.75%Otros Sistemas2.69%2.64%2.59%2.54%2.50%2.45%2.40%2.84%Total cobertura20.83%21.20%35.68%42.98%50.11%53.71%55.71%55.06%Sin cobertura79.17%78.80%64.32%57.02%49.89%46.29%44.29%44.94%

Otros SistemasAfiliados ContributivoAfiliados SubsidiadoSin coberturaCobertura Seguridad Social Total 1993-2000

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Otros SistemasAfiliados ContributivoAfiliados SubsidiadoAfiliados Seguridad Social en Salud 1993-2000

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1,9931,9941,9951,9961,9971,9981,9992,000Recursos Subsidiado00696,133867,3571,018,8701,236,4241,346,1751,379,032Recursos Contributivo1,952,3612,037,4322,305,5482,883,0923,533,3603,595,8953,736,8823,651,213Recursos Otros Sistemas290,000290,000290,000290,000290,000290,000290,000347,970Sin Recursos8,524,5548,648,8227,885,3927,355,3326,776,3576,717,4586,687,7586,894,987Total poblacin10,766,91610,976,25411,177,07311,395,78111,618,58711,839,77712,060,81512,273,2021,9931,9941,9951,9961,9971,9981,9992,000Recursos Subsidiado696,132,820867,357,2301,018,870,0501,236,423,8451,346,175,0701,379,032,070Recursos Contributivo1,952,361,4902,037,431,8302,305,548,4302,883,091,9833,533,360,2373,595,895,2913,736,882,2933,651,212,850Recursos Otros Sistemas290,000,000290,000,000290,000,000290,000,000290,000,000290,000,000290,000,000347,969,840Sin Recursos8,524,554,0608,648,821,6707,885,391,7407,355,332,2076,776,356,6836,717,457,5046,687,757,8576,894,987,180Total poblacin10,766,915,55010,976,253,50011,177,072,99011,395,781,42011,618,586,97011,839,776,64012,060,815,22012,273,201,9402242361490232743183032916812504040449212.583334842230287.0755122319135.771295373057363.112375378214760.0580800696132.82867357.231018870.051236423.8451346175.071379032.071952361.492037431.832305548.432883091.982583333533360.2370753595895.290771293736882.293112373651212.85005808290000290000290000290000290000290000290000347969.848524554.068648821.677885391.747355332.207416676776356.6829256717457.504228716687757.856887636894987.1799419210766915.5510976253.511177072.9911395781.4211618586.9711839776.6412060815.2212273201.941,9931,9941,9951,9961,9971,9981,9992,000Recursos Subsidiado0.00%0.00%6.23%7.61%8.77%10.44%11.16%11.24%Recursos Contributivo18.13%18.56%20.63%25.30%30.41%30.37%30.98%29.75%Recursos Otros Sistemas2.69%2.64%2.59%2.54%2.50%2.45%2.40%2.84%Sin Recursos79.17%78.80%70.55%64.54%58.32%56.74%55.45%56.18%Total poblacin10,766,91610,976,25411,177,07311,395,78111,618,58711,839,77712,060,81512,273,202000.06228221110.07611213290.08769311210.10442965970.11161559530.11236123030.18132969290.18562179070.20627479410.2529964270.3041127330.3037131020.30983662590.29749472610.02693436190.02642067260.025945970.02544801360.0249600060.02449370530.02404480910.02835200151,9931,9941,9951,9961,9971,9981,9992,00020010.20826405480.21204246330.29450297520.35455657350.41676585110.4326364670.44549703030.4382079580.20826405480.21204246330.29450297520.35455657350.41676585110.4326364670.44549703030.43820795800.250.30.350.40.450.50.550.60.650.70.75

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Evolucin de los recursos faltantes para el aseguramiento universal en valor presente del 2000(millones de pesos)

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Recursos ContributivoRecursos Otros SistemasRecursos SubsidiadoSin RecursosSeguridad Social en Salud en trminos de recursos necesarios y faltantes sobre la base de un costo per cpita de 290.000 pesos (millones de pesos)

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Recursos ContributivoRecursos Otros SistemasRecursos SubsidiadoSin RecursosCobertura de la seguridad Social en Salud en trminos de recursos para financiar costo per cpita del R. Contributivo

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Cobertura del Sistema de Seguridad Social en Salud proyectada a 25 aos

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Cobertura Rgimen Contributivo proyectada a 25 aos

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Cobertura Rgimen Subsidiado proyectada a 25 aos

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1,9931,9941,9951,9961,9971,9981,9992,0001,9931,9941,9951,9961,9971,998Recursos Subsidiado00696,133867,3571,018,8701,236,4241,346,1751,379,032Recursos Subsidiado720,137,400897,266,1001,054,003,5001,065,882,625Recursos Contributivo1,952,3612,037,4322,305,5482,883,0923,533,3603,595,8953,736,8823,651,213Recursos Contributivo1,383,561,5001,447,385,2501,663,860,5002,176,452,2502,629,836,2502,979,497,250Recursos Otros Sistemas290,000290,000290,000290,000290,000290,000290,000347,970Recursos Otros Sistemas250,000,000250,000,000250,000,000250,000,000250,000,000250,000,000Recursos de Oferta1,147,8891,344,0321,816,3911,822,3071,816,9291,774,3561,751,2051,599,664Sin recursos7,648,262,2507,764,902,2507,001,409,8506,500,231,1506,082,183,5005,911,324,125Recursos faltantes7,376,6657,304,7906,069,0005,533,0264,959,4274,943,1014,936,5535,295,323Total poblacin10,766,91610,976,25411,177,07311,395,78111,618,58711,839,77712,060,81512,273,202Total poblacin9,281,823,7509,462,287,5009,635,407,7509,823,949,50010,016,023,25010,206,704,0001147888993.759551344031653.76651816391308.71041822306528.952641816929353.64451774356331.381051751204539.796291599664495.903142,242,3612,327,4323,291,6814,040,4494,842,2305,122,3195,373,0575,378,215199319941995199619971998Recursos Subsidiado0.00%0.00%6.23%7.61%8.77%10.44%Recursos Contributivo18.13%18.56%20.63%25.30%30.41%30.37%Recursos Otros Sistemas2.69%2.64%2.59%2.54%2.50%2.45%Recursos de Oferta10.66%12.24%16.25%15.99%15.64%14.99%Sin Recursos68.51%66.55%54.30%48.55%42.69%41.75%Total poblacin100.00%100.00%100.00%100.00%100.00%100.00%898196443.641050819411.481420129682.161424754446.721420550349.213412794801,9931,9941,9951,9961,9971,9981,9992,000Afiliados Subsidiado002,400,4582,990,8873,513,3454,263,5314,641,9834,755,283Afiliados Contributivo6,732,2817,025,6277,950,1679,908,87412,049,67212,399,63912,885,80112,590,389Otros Sistemas1,000,0001,000,0001,000,0001,000,0001,000,0001,000,0001,000,0001,199,896Transformacin Oferta3,958,2384,634,5926,263,4186,283,8166,265,2746,118,4706,038,6365,516,084Sin cobertura25,436,77625,188,93120,927,58819,079,39917,101,47417,045,17617,022,59818,259,733Total poblacin37,127,29537,849,15038,541,63139,295,79840,064,09340,826,81641,589,01842,321,3861,9931,9941,9951,9961,9971,9981,9992,000Afiliados Subsidiado002,400,4582,990,8873,513,3454,263,5314,641,9834,755,283Afiliados Contributivo6,732,2817,025,6277,950,1679,908,87412,049,67212,399,63912,885,80112,590,389Otros Sistemas1,000,0001,000,0001,000,0001,000,0001,000,0001,000,0001,000,0001,199,896Transformacin Oferta3,958,2384,634,5926,263,4186,283,8166,265,2746,118,4706,038,6365,516,084Sin cobertura25,436,77625,188,93120,927,58819,079,39917,101,47417,045,17617,022,59818,259,733Total poblacin37,127,29537,849,15038,541,63139,295,79840,064,09340,826,81641,589,01842,321,3867,732,2818,025,62711,350,62513,899,76116,563,01717,663,16918,527,78418,545,56819931994199519961997199819992000Afiliados Subsidiado002,400,4582,990,8873,513,3454,263,5314,641,9834,755,283Afiliados Contributivo6,732,2817,025,6277,950,1679,908,87412,049,67212,399,63912,885,80112,590,389Otros Sistemas1,000,0001,000,0001,000,0001,000,0001,000,0001,000,0001,000,0001,199,896Transformacin Oferta3,958,2384,634,5926,263,4186,283,8166,265,2746,118,4706,038,6365,516,084Sin cobertura25,436,77625,188,93120,927,58819,079,39917,101,47417,045,17617,022,59818,259,733Total poblacin37,127,29537,849,15038,541,63139,295,79840,064,09340,826,81641,589,01842,321,38619931994199519961997199819992000Recursos Subsidiado0.00%0.00%6.23%7.61%8.77%10.44%11.16%11.24%Recursos Contributivo18.13%18.56%20.63%25.22%30.08%30.37%30.98%29.75%Recursos Otros Sistemas2.69%2.64%2.59%2.54%2.50%2.45%2.40%2.84%Recursos de Oferta10.66%12.24%16.25%15.99%15.64%14.99%14.52%13.03%Sin Recursos68.51%66.55%54.30%48.55%42.69%41.75%40.93%43.15%Total100.00%100.00%100.00%100.00%100.00%100.00%100.00%100.00%

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Recursos ContributivoRecursos Otros SistemasRecursos SubsidiadoRecursos de OfertaRecursos faltantesRecursos totales disponibles y faltantes en el Sistema frente al valor del aseguramiento del total de la poblacinvalor presente pesos 2000

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Recursos Otros SistemasRecursos ContributivoRecursos SubsidiadoSin recursosRecursos del aseguramiento en salud

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Recursos Otros SistemasRecursos ContributivoRecursos SubsidiadoSin recursosCobertura de aseguramiento en salud

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Afiliados ContributivoOtros SistemasAfiliados SubsidiadoTransformacin OfertaSin coberturaAfiliados posibles al R. Contributivo con cada grupo de los recursos del Sistema

000000000000000000000000000000

Otros SistemasAfiliados ContributivoAfiliados SubsidiadoTransformacin OfertaSin cobertura

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Recursos ContributivoRecursos Otros SistemasRecursos SubsidiadoRecursos de OfertaSin Recursos

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Recursos ContributivoRecursos Otros SistemasRecursos SubsidiadoRecursos de OfertaPorcentaje de poblacin que es posible cubrir al costo del afiliado al Rgimen Contributivo

199419951996199719981999200019941995199619971998199920001994199519961997199819992000R. Contributivo21%28%35%42%49%56%63%R. Contributivo18.56%20.63%25.30%30.41%30.37%30.98%29.75%0.2974947261R. Contributivo21%28%35%42%49%56%63%R. Subsidiado0%12%22%26%28%28%27%R. Subsidiado0.00%12.46%15.22%17.54%20.89%22.32%22.47%R. Subsidiado0%12%22%26%28%28%27%21%40%57%68%77%84%90%18.56%33.08%40.52%47.95%51.26%53.31%52.22%21%40%57%68%77%84%90%19961997199819990%12%22%26%28%28%27%01.83333333331.18181818181.076923076910.96428571430.8333330.18180.07690199419951996199719981999200019941995199619971998199920001994199519961997199819992000Cobertura proyectada21.00%40.00%57.00%68.00%77.00%84.00%90.00%Tendencia proyectada21.00%28.00%35.00%42.00%49.00%56.00%63.00%Tendencia proyectada21.00%40.00%57.00%68.00%77.00%84.00%90.00%Cobertura observada18.13%31.02%35.85%42.84%51.30%52.69%53.46%Tendencia encontrada18.56%20.63%25.30%30.41%30.37%30.98%29.75%Tendencia observada18.56%33.08%40.52%47.95%51.26%53.31%52.22%Diferencia2.87%8.98%21.15%25.16%25.70%31.31%36.54%Diferencia2.44%6.92%16.48%20.05%25.74%30.69%37.78%Rgimen Subsidiado19941995199619971998199920001994199519961997199819992000Tendencia Proyectada0%12%22%26%28%28%27%Tendencia Proyectada0-0.00456442230.06777573420.08461377570.07114068070.05676880950.0452775394Tendencia Encontrada0%12%15%18%21%22%22%Tendencia Encontrada00.06228221110.07611213290.08769311210.10442965970.11161559530.1123612303Recursos reales0%6%8%9%10%11%11%Recursos reales00.06228221110.07611213290.08769311210.10442965970.11161559530.1123612303Tendencia Encontrada0%6%8%9%10%11%11%Tendencia Proyectada0%-0%7%8%7%6%5%

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R. ContributivoR. SubsidiadoCobertura Propuesta en Proyecto Inicial

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R. ContributivoR. SubsidiadoCobertura observada Regmenes de Seguridad Social en Salud

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Cobertura proyectadaCobertura observadaCobertura total proyectada y observada Rgmenes de Seguridad Social en Salud

0.210.18562179070.280.20627479410.350.2529964270.420.3041127330.490.3037131020.560.30983662590.630.2974947261

Tendencia proyectadaTendencia encontradaRgimen Contributivo Tendencia de Cobertura Proyectada y Encontrada

000.120.12456442230.220.15222426580.260.17538622430.280.20885931930.280.22323119050.270.2247224606

Tendencia ProyectadaTendencia EncontradaCobertura Proyectada y Observada Rgimen Subsidiado

0000.120.12456442230.06228221110.220.15222426580.07611213290.260.17538622430.08769311210.280.20885931930.10442965970.280.22323119050.11161559530.270.22472246060.1123612303

Tendencia ProyectadaTendencia EncontradaRecursos realesCobertura Proyectada y Observada en afiliados y recursos Rgimen Subsidiado

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Recursos realesTendencia EncontradaTendencia ProyectadaCobertura Rgimen Subsidiado proyectada, observada y en recursos aos 1994-2000

I.S.S.1,9921,9931,9941,9951,9961,9971,998pensionados260,510282,229291,507322,819346,739372,433400,030beneficiarios255,524272,905272,977302,298324,699348,759374,602total afiliados518,026557,127566,478625,117671,438721,192774,632dens fliar0.980.970.940.940.940.940.94proy rever pens260,510279,814300,548322,819346,739372,433400,030tasa crec.pens1.0751.0741.0741.0741.0741.0741.074afil OIT5,049,8545,515,5465,789,5415,987,6526,395,9037,155,563Total afil+pens OIT5,567,8806,072,6736,356,0196,612,7697,067,3417,876,755TOTAL AFIL COMP7,841,9807,330,463Total cot3,427,6593,707,2153,847,8063,969,8263,926,3013,888,5973,427,647dens fliar1.6241.6381.6521.6661.82.0172.119tasa crec dens. Fliar.1.00841.00841.00841.08061.051amarillo es compensacionrojo es estimacion1,9921,9931,9941,9951,9961,9971,998Afiliados y benef OIT5,049,8545,515,5465,789,5415,987,6526,395,9037,155,563pensionados y sus beneficiarios518,026557,127566,478625,117671,438721,192774,632Subtotal5,567,8806,072,6736,356,0196,612,7697,067,3417,876,755Afiliados por compensacin7,841,9807,330,463Total estimado5,567,8806,072,6736,356,0196,612,7697,067,3417,841,9807,330,463

afiliados19921993199419951996199719981992199319941995199619971998AoCotizantes3.7284.0084.284.54.74.95.019Cotizantes3.7284.0084.284.54.74.95.019Cotizantes7.51%6.79%5.14%4.44%4.26%2.43%7.51%6.79%5.14%4.44%4.26%2.43%BeneficiariosCotizantesBeneficiariosTotal afiliados37072155000000Total19966,632,4297,095,86813,728,2972.06987470219976,991,9627,977,31614,969,2782.140926681219985,865,12310,225,60116,090,7242.74345891811999*5,631,2688,021,61013,652,8782.4244766898compensados199719985382597124298742.309270785119995238390125628482.398226936119931998199920006732281702562779501679908873.6753607512049672.001194112399638.933694112885801.010732312590389.1381313199219931994199519961997199819991.68003987812.309272.39822Beneficiarios213822923634652777979.13447660.2265136216.494920756990655.389927687047277751273219921993199419951996199719981999Cotizantes372765940072154247647.94502506.7744772657.180445059016.61126645362557.607942385373069372765940072155369505.919054115373068.7804839958658886732281702562779501679908873.6753607512049672.001194112399638.933694112885801.0107323372765940072154247647.94502506.7744772657.180445059016.61126645362557.6079423853730690.57361174940.58980239390.65400409010.76572016411.07617545131.38182099941.31416341141.39821991.07499505721.061.061.061.061.061.00066353621992199319941995199619971998Cotizantes proyectados3.7284.008Cotizantes observados3.7284.0084.284.54.74.95.0191992199319941995199619971998EPS Privadas1,547,141ISS3,427,6593,707,2153,846,8063,969,8263,926,3013,888,5973,427,647Otras EPS Pblicas y mixtas330,310330,310330,310E. Adaptadas77,49977,49977,4994,115,0244,296,4065,382,5971,267,573Incremento-100.00%0.00%0.00%0.00%25.28%

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Cotizantes

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CotizantesBeneficiarios

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