República de Colombia

POPULATION : % over 60 years 51.4 % females 48.6 % males

PRIVATE PRE-PAID CONTRIBUTIVE Workers Employees 12.5% salary 38.77% SUBSIDIZE Unable to pay for health Subsidy by Goverment and contributive 50.59% COLOMBIAN HEALTH CARE SYSTEM Before 1990 Health coverage 30.4% Law 100 / 1993 : Achive universal access to social security

DISEASE ESTIMATED NUMBER OF PATIENTS AFFECTED WITH THE DISEASE PATIENTS IN NEED OF PALLIATIVE CARE COPD Congestive heart failure Neurologic development disorders Cerebrovascular Dementia Epilepsy Peripheral neuropathy Parkinson Disease Craneoencephalic trauma sequelae HIV/AIDS Cancer Chronic kidney disease TOTAL ESTIMATED OF PATIENTS IN NEED OF PALLIATIVE CARE PREPOCOL Stud. Chest 2008; 133(2): Rev Colomb Cardiol 2009; 16(6): Rev Panam Salud Pública 2003;14(2):

PALLIATIVE CARE EDUCATION 3 Postgraduate Programs: – For Anesthesiologist, Family Practice, Oncologist, Rehab ( 1 year) – For MD,Nurses, psycologist ( 3 years) 1Undergraduate Program: -For last year medical students as an obligatory course

PALLIATIVE CARE PROGRAMS CALI MEDELLIN BOGOTA BARRANQUILLA BUCARAMANGA VILLAVICENCIO CARTAGENA PEREIRA PASTO (9 de 32): 28%

Qualitative analysis Strong points: 1. Education 2. Medications 3. Cancer Law Weak points: 1. No reliable data 2. No economical studies 3. No Palliative Care Plan 4. Not enough people trained 5. Not enough PC services

Main dilemmas & challenges Dilemmas: 1. Is palliative care cost-efective in Colombian Health System Challenges: 1.Economical studies 2.Improve Education 3.Access to services and availability of medication 4.Include Palliative care in standars of quality of care