Empresas promotoras de saúde no sistema de saúde colombiano: dinâmica financeira estrutural.

Abstract

This thesis analyzes the Empresas Promotoras de Salud (EPS meaning health promoting entity), which are health insurance companies that act in the Colombian health system since the health reform law of 1993 (Law 100). Based on a document analysis and within a critical political economy framework, we firstly address the relations between the financialization process in the capitalist system, the structural reforms and the health care reform, with the EPS s financial dynamics, and secondly address the reproduction of financialization mechanism inside the EPS including financial leverage; expanded reproduction of capital through the public debt; and investments in securitized assets. Most EPS are private for profit companies, which quickly formed an oligopolistic market and exemplify internationally recognized contradictions of the Managed Care and Managed Competition models, also as its for¬profit orientation and functioning has been related to the exacerbation of health inequities and has further been recognized as a driver of suffering and death in the population. This has primarily been related to the oligopolistic concentration of the private health insurance market, whose companies are organized as a cartel, hindering access to health services for the population. When social mobilization forced to increase control over the EPS, they began to leave the market declaring themselves bankrupt, or suddenly entered negative financial statements.