[Neurology and the reform of the health care system in Colombia].
OBJECTIVE
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 follow-up of a similar study on the practice of neurology done by the authors before the reform.


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.
Rosselli
D
D
Unidad de Epidemiología Clínica y Bioestadística, Universidad Javeriana, Bogotá, Colombia. diego_rosselli@post.harvard.edu
Calderón
C
C
Sánchez
J F
JF
Rodríguez
M N
MN
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003105:Colombia; D005260:Female; D018166:Health Care Reform / Q000191:economics / Q000331:legislation & jurisprudence*; D006298:Health Services Administration; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009462:Neurology; D012189:Retrospective Studies; D011795:Surveys and Questionnaires