Colombia

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Patient Access to Physiotherapy or Physical Therapy Services / Entry Point

In Colombia patients have access to physical therapy either through private health insurance or goverment health insurances. All Colombians have mandatory affiliation to health insurance services provided largely by the goverment, which are called EPS ( Entidad Promotora de Salud), IPS (Instituciones Prestadoras de Servicios) or POS (Plan Obligatorio de Salud).In all cases a physician referral is necessary, except for those who will pay privately. 1 

The physicians or EPS are the ones who determine when therapy services start and when do they finish. The frequency, length and amount of sessions need previous insurance authorizacion and are based on the type of insurance and not so much the need of the patient.1


Therapist Preparation

In order for students to initiate a physical therapy program, first they need to pass a national competence test upon high school graduation.This test is called ICFES. According to the score in this test students can be admitted in public or private colleges or universities, usually goverment colleges demand a high ICFES score.2

All entry level programs in Colombia are Bachelors' level and last anywhere from eight to ten semesters. The last one or two semesters are internship programs in public health institutions under direct or indirect teacher supervision. 

Degree/Credentialing

There are currently thirty-four accredited programs nationwide. Upon completion of the program, all graduates will register with the department of health and be appointed a license to practice. Completion of the program alone will grant the license and there are no national physical therapy tests requiered in order to become licensed. 7

Specialization

There are several colleges and universities throughout the country that offer nine main specialty approaches:

  • Neuro-Rehabilitation
  • Adult Critical Care
  • Cardiopulmonary
  • Trauma and Orthopedia 3
  • Manual Therapy 
  • Therapeutic Physical Activity
  • Hand and Upper Extremity Rehabilitation
  • Comprehensive Integration in Motor Disability
  • Management and Formulation in Kinetic Conditioning Programs 4

Professional Associations

  • Colombian Physiotherapy Association- Asociación Colombiana de Fisioterapia (ASCOFI): Non-profit national entity formed by physitherapist whose main objective is to defend and look for the integral development for the profession in all areas. 5


  • Colombian Association of Physiotherapy Students -Asociación Colombiana de Estudiantes de Fisioterapia (ACEFIT): This is an independent, non-profit entity that contributes to the progress, development and comprehensive training of students associated through programs of academic, cultural, social,economic and personal development. This association is made up by different chapters nationwide. 6




Information about the Patient Community

The total population of Colombia is 48'203,000 inhabitants. Between the years 2010 and 2015 the total life expectancy in Colombia was 75.2 years. Male: 72.1 years, female: 78.5. Gross mortality rate: 5.8 per 1,000 inhabitants. Gross birth rate:18.9 per 1,000 inhabitants.

In Colombia, the highest cause of death between 2010 and 2014 was ischemic heart disease, followed by cerebro-vascular accident, chronic lower respiratory infections, diabetes and hypertension. Other significant death causes were cancer, homicides, motor-vehicle accidents and perinatal conditions.  Approximately 6.5% of the total colombian population suffer some kind of disability.7



Social/Cultural Influences

Colombia has an abundance of families that belonged to the middle-class sector of society and are struggling between the need to survive and the desire to give their children a good education. The lower-middle class, constituting the bulk of the middle class, comes primarily from upwardly mobile members of the lower class. A large number are clerks or small shopkeepers. Many have only a precarious hold on middle-class status and tend to be less concerned with imitating upper-class culture and behavior than with making enough money to sustain a middle-class lifestyle. Such families tend to be just as concerned as those at higher social levels with giving their children an education. Many hope to send at least one of their children through a university, regardless of the financial burden.8.

10.4% of the population lives in houses with inappropiate physical characteristics, because either they are mobile homes, shelters or because they lack proper walls and flooring. 72% of the total households have access to drinking water during food preparation and 77% have access to garbage pick-up services.9


Delivery of Care

According with the complexity of the activites, procedures and interventions, the following, are the levels of health care in Colombia:

First level: To this level belong all local hospitals where basic care is provided. They only have general medical care for consultations and surgical procedures are not performed at all. Ocassionally, general dentistry is offered.

Second Level: They are called second-tier regional hospitals.These hospitals are better equipped. They have at least four specialists: anesthesiologist, surgeon, gynecologist and internal medicine. They also have medical laboratory with the capacity to practice basic blood tests, urine and stool.

Third Level: They are called tertiary referral hospitals or highly specialized, they come to patients referred from regional hospitals. These hospitals have large number of specialists: cardiologists, dermatologists, psychiatrists, neurologists and nephrologists, among others.10



Type of Health System

The health system is basically composed of three entities:

The state (government) : acts as a coordinating body, management and control. Their bodies are: The Ministry of Health and Social Protection (Colombia) , the Regulatory Commission in Health (CRES) which replaced the National Council of Social Security in Health (CNSSS) by Law 1122 of 2007 and the National Superintendency health that monitors and controls the players in the system.

Insurers : These are private entities that provide the population, act as intermediaries and managers of the resources provided by the state in the form of premium annual called Unit Capitation Payment -UPC-. They are health promotion entities (EPS) and occupational risk managers (ARL).

Providers : are health institutions (IPS), they are hospitals, clinics, laboratories, etc. directly providing service to users and provide all necessary resources for the restoration of health and prevention of disease, independent health professionals (doctors, nurses, etc.) and specialized transporters patients (ambulances).11


Payment System

Care common disease and non - occupational accidents :
For care related to general illness and non - occupational risk the government allocates health resources which are managed by the Solidarity Fund and Guarantee (FOSYGA) created from Article 218 of Law 100 of 1993 and Article 1 of Decree 1283 of 23 July 1996 as an attached note to the Ministry of social Protection managed by trust management and who is in charge of making a distribution to each of its sub - accounts to cover all fronts of the social security system. Reference is made to each of the subaccounts that has the FOSYGA:

ECAT subaccount: This subaccount corrects the cost of care for victims of traffic accidents through SOAT and victims of catastrophic events and terrorist. The SOAT covers, comprehensive inpatient care, drug delivery, payment procedures, diagnostic and rehabilitation requires the patient to complete an amount of 800 statutory minimum wages, if patient care exceeds this amount the cost overrun will be in charge EPS to which the user is affiliated. The attending physician in the emergency department must fill out a form for this type of accidents which must be attached along with a copy of SOAT for the respective collection to Fosyga.
Subaccount compensation: Raises the value of compensation in the contributory scheme, meaning compensation discounting charges levied by the EPS and other obligated to compensate arising from health and pension discounts that employees and employers are held entities. Subaccount compensation funds the contributory scheme by paying UPC (Unit capitation payment), ie the CRES set a fixed rate for the UPC rate which by an affiliate user, this way the Fosyga with resources it is recognized account turn each UPC EPS value proportional to the number of members used regardless of whether these services or not.
Solidarity subaccount: Collects the resources contributed by all players in the system destined for the subsidized scheme (a part <1.5 of the contribution to EPS> is provided by all persons affiliated to the contributory scheme). The resources administered by the subaccount are intended to allow the affiliation of the poor and vulnerable population to this regime through a subsidy consisting of the payment of premium or UPC to the subsidized regime EPS demand. The more resources account for this coverage and achieving universality increase affiliating most poor and vulnerable in the subsidized regime.
Promotion subaccount: Financia education activities, information and health promotion and disease prevention, which are in the Basic Care Plan - PAB.
In the excepted schemes General System are like those of the Armed Forces, National Fund of the Magisterium, Ecopetrol and universities, funding is not provided by the Fosyga but by specific funds of each exempt regime, although these must provide resources to the subaccount solidarity with the Subsidized Regime General.l system is financed.

Care illness and accidents 
Main article: General System of Occupational Hazards (Colombia)
To care occupational hazards and events, accidents or illnesses of occupational origin resources come from the Fund Occupational Risk fed with employer contributions according to risk classification of each company.11



References


  1. http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0036-36342011000800010
  2. http://www.elsevier.es/es-revista-revista-iberoamericana-fisioterapia-kinesiologia-176-articulo-analisis-critico-educacion-fisioterapia-colombia-S1138604511000037
  3. http://www.cursosycarreras.co/posgrados-fisioterapia-TC-4-755
  4. http://www.educaedu-colombia.com/postgrado/fisioterapia
  5. http://www.ascofi.org.co/
  6. https://prezi.com/qt_rzk0lnprp/asociacion-colombiana-de-estudiantes-de-fisioterapia/
  7. https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/TH/Perfil-profesional-competencias-Fisioterapeut
  8. https://en.wikipedia.org/wiki/Social_class_in_Colombia
  9. http://www.paho.org/hq/dmdocuments/2010/Perfil_Sistema_Salud-Colombia_2009.pdf?ua=1
  10. http://www.eltiempo.com/archivo/documento/MAM-627858
  11. https://es.wikipedia.org/wiki/Sistema_de_salud_en_Colombia