Neurología y reforma del sistema de salud en Colombia

Introduction and objectives. Despite the magnitude of the Colombian health system reform, introduced in 1993, changes in specialized medical practice have not been evaluated. This paper is the follow­up of a similar study on the practice of neurology done by the authors before the reform. Material and methods. Of the 62 members of the Colombian Association of Neurology living in Bogotá, 47 (76%) of them responded an anonymous survey inquiring on the characteristics of their medical practice and registering all the medical encounters during one week in October 1998. Results. Two thirds of the total working time is devoted by neurologists to clinical work. Half of the neurologists in the sample have invested in diagnostic equipment. There was no significant change in the total number of patients attended during the week, as compared with the 1993 study, and the diagnostic profile was similar. The proportion of private patients was significantly lower, while patients from prepaid medical schemes increased. Patients belonging to the Obligatory Health Plan, designed to cover lowest income population, and to prepaid medicine are not distributed homogeneously throughout all ages. The first year of life is particularly uncovered by the Obligatory Health Plan, while prepaid schemes do not address the problems of individuals age 60 or more. Conclusions. There has been a significant reduction in private practice compensated by an increase in prepaid medicine. There is no evidence of increased coverage for neurological disorders.