This work makes an analysis about the institutional arrangements introduced with the Law 100 of 1993 to the Statal Social Organizations, and how those have impacted on the health service and the right guarantee; that's why the Hospital Simón Bolívar E.S.E. of Bogotá was chosen as an example during the years 2002 to 2014. It is explained how with the implementation of the decentralization, the insurance model and the financial autonomy the health service was affected, taking into account the introduction of the Health Promoting Entities.