ImpactU Versión 3.11.2 Última actualización: Interfaz de Usuario: 16/10/2025 Base de Datos: 29/08/2025 Hecho en Colombia
Comportamiento del gasto publico en salud y su incidencia en los niveles de morbilidad y mortalidad en el municipio de Fusagasugá en el periodo de 2008 a 2015
This work shows that an analysis of the resources allocated by the General System of Social Security in Health for public spending on health through the General System of Participations can contribute to identify whether or not it is possible to reduce mortality rates and manage morbidity levels in such a way as to optimize their incidence. The hypothesis put forward is that the allocation and execution of the resources of the General System of Participations in Health are not sufficient to decrease the existing mortality and morbidity rates in a municipality in Colombia, in this case in the municipality of Fusagasugá, for the period 2008 to 2015. In addition, comparisons were made with other cities, four with similar category two or three in the region of Cundinamarca and five other departmental capital cities in Colombia that are special districts. Within this framework, it is possible to optimize resources and maximize the welfare of a population by identifying the issues on which the greatest health expenditures should be made that allow decreasing mortality rates in a population according to the characteristics and epidemiological profile of existing morbidity. Since 1993 to date, the health system in Colombia has been adjusting, however, it is perhaps at one of its most critical moments. Although insurance coverage has increased, the estimated resource deficit (Clavijo, S. Peña, M, 2010) is projected to be around -3.8% of GDP in 2035, depending on factors such as labor formality and population growth, among others. Methodologies such as those proposed in this work are relevant to show that there is a relationship of elasticities that can help to identify the necessary health expenditure according to current medical knowledge that produce the adequate management of existing morbidity and as a result a decrease in mortality rates. Through an analytical investigation, the effects of public health expenditure and its effect on morbidity and mortality rates were analyzed following the methodology of econometric analysis with multiple regression panel data. Three different groups of models were estimated: total mortality, infant mortality, and morbidity for 4 types of diseases. The estimation methodologies used were Ordinary Least Squares (OLS), Panel Data with Fixed Effects (FE) and Random Effects (RE). Additionally, OLS models (Mortality and Infant Mortality) were estimated for Fusagasugá in order to find differences between cities/municipalities in relation to the associated mortality of each model. The models that were estimated have the log-log functional form following (Claxton, et al., 2018) and (Rezapour, et al., 2019) functional form adopted to measure income elasticities with respect to total mortality, infant mortality, and some types of morbidities. When observing general mortality, it was found that public spending on health given by investment in health had a significant impact on the decrease in general mortality, as did education and other sociodemographic variables. When analyzing the first five causes of death in the municipality of Fusagasugá, we found that public spending on health during the period under study had a positive and significant impact, as shown by the estimates in the presentation of deaths from acute ischemic heart disease, chronic respiratory tract diseases, cerebrovascular diseases, pneumonia, hypertensive diseases, malignant stomach tumor, diabetes mellitus and renal insufficiency as the main morbidities causing the mortality rate; some findings such as homicides or motor transport accidents, which are also among the first ten causes of mortality, could benefit from health care but not in the mitigation of the causes. The OLS model for four selected causes of morbidity showed that coronary ischemic diseases and chronic respiratory diseases have negative coefficients, suggesting that when investment in public health increases, mortality in these diseases is reduced. With the municipality of Fusagasugá, an analysis was carried out using a dummy variable model to observe the mortality differentials between cities/municipalities. The OLS estimation was carried out for the general mortality variables, showing a higher mortality rate compared to the other municipalities, and with infant mortality it was shown that infant mortality decreases when investment in public health increases. Public health policies that intervene preventively in the target population according to morbidities and higher mortality rates should be the appropriate route for disease control and management. The financing and distribution of public resources for health have a positive impact on the quality of the provision of health services, decreasing total and infant mortality rates in the cities reviewed and in the municipality of Fusagasugá. The working hypothesis was tested and the significance is better observed in the estimation of the data. It is recommended that the health system should have institutions that last over time, that can constantly adapt to the evolution of scientific knowledge, finite resources and environmental change.