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Analizar el diseno institucional de la prestacion de servicios de salud en Colombia, resulta indispensable para comprender los resultados de las politicas de salud actuales. Para este fin, se tomo como referencia las instituciones y las organizaciones que han dado forma al actual modelo que identifican dos niveles de tension. El primer nivel suscitado por las tensiones inherentes a la prestacion de servicios de salud o la asistencia sanitaria como bien economico, el cual se ha defendido desde mecanismos de provision de mercado hasta mecanismos totalmente centralizados comandados por el Estado. Cada uno de estos esquemas genera tensiones entre los actores directamente implicados en la provision y en la demanda, tales como los pacientes, medicos, prestadores, aseguradoras y Estado. El segundo nivel se refiere a las tensiones institucionales que se han manifestado desde la puesta en marcha del sistema colombiano y las garantias constitucionales, en las cuales la Corte Constitucional ha delineado nuevas formas de prestacion. Abstract Analyzing the institutional design of the health services in Colombia, it is essential to comprehend the results of the actual health policies. In order to accomplish this, it was taken as reference the institutions and organizations that have given form to the actual model, where can be seen two levels of tensions. The first level comes from the tensions inherited by the health services or the sanitary assistance as an economic commodity, which has been defended like a mechanism that provides the market to a totally centralized mechanism commanded by the State. Each one of those schemes generate a tension between the directly implicated actors in the supply and demand system, such as patients, physicians, providers, insurance companies and the State. The second level refers to the institutional tensions that have been manifested since the start of the Colombian system and the constitutional guarantees, on which the Constitutional Court has outlines new forms of services.

Tensiones institucionales en el sistema de salud colombiano