The paper will be 3 to 4 pages (excluding the title page and reference page) and written in APA format. A minimum of three (3) current references (within the last five years) should be cited on the reference list.


NUR 4667 Globalization in Nursing

Scholarly Paper Guidelines

For this paper the student will choose one topic from either of the two main subject areas of:

1) Description of a Health System

2) Global Health Issue

The paper will be 3 to 4 pages (excluding the title page and reference page) and written in APA

format. A minimum of three (3) current references (within the last five years) should be cited

on the reference list. This paper will be submitted via TURN-IT-IN on the course Blackboard

website. After submission, a rating of 0-15% similarity will be considered acceptable. Over

15% will not be considered acceptable.

A) Healthcare Delivery System of a Country (Choose your country from the list below, or if

you wish to do another country please gain approval from the instructor). You should attempt to

answer the following questions in your paper:

1. How is health care delivered? Ex. in hospitals, private clinics, public clinics?
2. How is health care acquired? Ex. private pay, insurance, government subsidy?
3. Who pays for health care? Ex. if insurance is available does the employer pay, or is

privately purchased?

4. How is the population cared for when chronically ill? Ex. family members, hospitals for
rehabilitation, private houses who care for the ill?

5. How is the population cared for when dying? Ex. family members? Hospice? At home or

6. How is the patient selected to have a procedure done or not? Ex. Is the patient able to
decide how to be treated?

You may choose one of the following Countries to explore their Healthcare System. More

than one student may choose the same country, but this is individual work:

Mexico, Japan, Canada, Brazil, Cuba, France, Spain, Germany, Israel, Italy, Denmark,

Greece, Belgium, Ecuador, Haiti, Chile, Colombia, Argentina, United Arab Emirates

B) Global Health Problem – Choose from the following issues and discuss how they affect the

world. Include examples and statistics which show how underdeveloped countries as well as

developed countries are affected. (Please note there are chapters in the book about these topics,

however you should not copy from your text!!)

1. Environmental Health
2. Maternal & Child Health
3. Nutrition
4. Ethical Issues/Human Rights

César Ernesto Abadı́a-Barrero
Department of Anthropology and Human Rights Institute
University of Connecticut and Centro de Estudios Sociales
Universidad Nacional de Colombia (E-mail: [email protected])

Neoliberal Justice and the Transformation
of the Moral: The Privatization of the Right to
Health Care in Colombia

Neoliberal reforms have transformed the legislative scope and everyday dynamics
around the right to health care from welfare state social contracts to insurance mar-
kets administered by transnational financial capital. This article presents experiences
of health care–seeking treatment, judicial rulings about the right to health care, and
market-based health care legislation in Colombia. When insurance companies deny
services, citizens petition the judiciary to issue a writ affirming their right to health
care. The judiciary evaluates the finances of all relevant parties to rule whether a
service should be provided and who should be responsible for the costs. A 2011 law
claimed that citizens who demand, physicians who prescribe, and judges who grant
uncovered services use the system’s limited economic resources and undermine the
state’s capacity to expand coverage to the poor. This article shows how the consol-
idation of neoliberal ideology in health care requires the transformation of moral
values around life. [neoliberalism, morality, justice, health care reform, health as a
human right]

Starting in the mid-1980s, the International Monetary Fund and the World Bank,
the two main international lending agencies, conditioned lending new funds to the
majority of Latin American countries on their implementation of structural adjust-
ment policies (Iriart et al. 2001). In health, the World Bank argued that the private
sector was more efficient than the public sector and that the deep crisis around
financing the region’s health care systems was largely attributable to their public
administration. The policies that they imposed intended to force the incorporation
of foreign financial institutions as administrators of private health insurance mar-
kets (Homedes and Ugalde 2005; Iriart et al. 2011; Iriart et al. 2001). Neoliberal,
managed care, and market-based health care reforms are all terms that have been
used to refer to the legal restructuring that allowed insurance companies to access
the country’s social security funds.

Colombia followed World Bank guidelines most closely. Through Law 100 of
1993 (Congreso de la República de Colombia, Diario Oficial 41.148, December


MEDICAL ANTHROPOLOGY QUARTERLY, Vol. 30, Issue 1, pp. 62–79, ISSN 0745-
5194, online ISSN 1548-1387. C© 2015 by the American Anthropological Association. All rights
reserved. DOI: 10.1111/maq.12161


D E C E M B E R 2 0 1 6 V O L U M E 1 8 N U M B E R 2 H ea l t h a n d H u m a n R i g h ts J o u r n a l 49

Closing the Gap Between Formal and Material Health
Care Coverage in Colombia

everald o l amprea and johnat tan garcía


This paper explores Colombia’s road toward universal health care coverage. Using a policy-based

approach, we show how, in Colombia, the legal expansion of health coverage is not sufficient and requires

the development of appropriate and effective institutions. We distinguish between formal and material

health coverage in order to underscore that, despite the rapid legal expansion of health care coverage, a

considerable number of Colombians—especially those living in poor regions of the country—still lack

material access to health care services. As a result of this gap between formal and material coverage,

an individual living in a rich region has a much better chance of accessing basic health care than an

inhabitant of a poor region. This gap between formal and material health coverage has also resulted

in hundreds of thousands of citizens filing lawsuits—tutelas—demanding access to medications and

treatments that are covered by the health system, but that health insurance companies—also known as

EPS— refuse to provide. We explore why part of the population that is formally insured is still unable to

gain material access to health care and has to litigate in order to access mandatory health services. We

conclude by discussing the current policy efforts to reform the health sector in order to achieve material,

universal health care coverage.

Everaldo Lamprea, LLB, JSD, is Assistant Professor at University of Los Andes Law School, Bogotá, Colombia.

Johnattan García, LLB, is Clinical Instructor at the Environmental and Public Health Law and Policy Clinic at the University of Los
Andes, Bogotá, Colombia.

Please address correspondence to the authors c/o Everaldo Lamprea, Facultad de Derecho, Universidad de los Andes, Bogotá, D.C.,
Colombia. Email: [email protected].

Competing interests: None declared.

Copyright: ©Lamprea and García. This is an open access article distributed under the terms of the Creative Commons Attribution Non-
Commercial License (, which permits unrestricted noncommercial use, distribution,
and reproduction in any medium, provided the original author and source are credited.

H ea l t h a n d H u m a n R i g h ts J o u r n a l


HHR_final_logo_alone.indd 1 10/19/15 10:53 AM

E. lamprea and J. garcía / UHC a

Nursing Inquiry. 2018;25:e12242.  |  1 of 8

© 2018 John Wiley & Sons Ltd

The result is that people come to feel quite happy in their
oppression like the prisoner who after 10 years in jail de-
cides it is not such a bad place, with its warm bed and
three meals a day (David Smith, 1999)


Sometimes, as with the prisoner, we just give up trying to know
what is beyond the bars. Why? Perhaps we are satisfied with the
way we are living or we encounter an overwhelming sense of not
knowing what we would do if we were free. We then become like
the prisoner who considers after 10 years that he only needs a

warm bed and three meals a day. Is this the easy way to feel safe in
the world? How is it possible to feel fulfillment when our world is
limited by others?

Living in the world is a unique experience for all. What do we
do, however, when the experience involves marginalization, alien-
ation, or oppression? Judgments must be made, and actions must
be taken to bring about positive change in those situations. In the
current era of globalization, political power has changed its task
to that of administering life as the machinery of production, and
human beings, as the centerpiece of globalization, must adjust to
the exigencies of the individualized, competitive, and consumer-
ist market to survive (Bourdieu, 1998). In addition, economic de-
velopment as a result of privatization of services has had serious
effects on the quality, accountability, distribution, access, and

Accepted: 11 March 2018

DOI: 10.1111/nin.12242


Understanding the space of nursing practice in Colombia: A
critical reflection on the effects of health system reform

Pilar Camargo Plazas

School of Nursing, Queen’s University,
Kingston, ON, Canada

Pilar Camargo Plazas, School of Nursing,
Queen’s University, Kingston, ON, Canada.
Email: [email protected]

Worldwide, healthcare has been touched by neoliberal policies to the extent that it
has some of its characteristics, such as being asymmetrical, competitive, dehuman-
ized, and profit driven. In Colombia, Law 100/93 was created as an ambitious reform
aimed at integrating the social security and public sectors of healthcare in order to
create universal access, and at the same time to generate market competence with
the objective of improving effectiveness and responsiveness. Instead, however,
Colombian health reform has served to generate competition which has aggravated
inequalities among people. Within this context, we practice nursing. As nurses, our
responsibility is to advocate for our patients. We cannot ignore what is hap

NUR 4667 / Professional Paper

Rubric for NUR 4667 Professional Paper

Criteria Outstanding Acceptable Unacceptable Points


Up to 10 points

Provides an introduction to the

topic of the paper. Explains the

significance and rationale for topic


Minimally compliant with


Non-compliant with



Up to 30 points

Provides a thorough discussion of

the topic and/or answers specific

questions depending on the topic


1) Description of a Health System

2) Global Health Issue

Although discussion of the

topic and/or answers the

questions are provided, they

lack rigor and depth.

Inadequate or minimal

discussion of the topic

and/or questions are left

unanswered. Non-compliant

with guidelines.

Literature Cited

Up to 10 points

A minimum of six (6) current

references (within the last five

years) are cited in the paper. Each

reference should be specifically

related to the topic or content of the


Six (6) current references

are selected, however they

were not appropriate to the

topic or content of the


Less than six (6) references

are selected, and/or one or

more of the references are

not current.


Up to 10 points

The conclusion of the paper

summarizes the information

presented, and relates the

knowledge gained back to the topic

of the paper.

Minimally compliant with


Non-compliant with


Organization &

Clarity of Writing

Up to 20 points

The paper flowed well with clarity,

and was suitably organized.

Writing is crisp, clear, and succinct.

The writer incorporates the active

voice when appropriate.

Writing and organization is

generally clear, but

unnecessary words are

occasionally used. Meaning

is sometimes hidden.

Paragraph or sentence

structure is often repetitive.

The paper poorly organized

and writing was difficult to

follow throughout. It is

hard to know what the

writer is trying to express.

Writing is convoluted.

APA Format,




65MEDICC Review, April–July 2017, Vol 19, No 2–3 Peer Reviewed

Since 1978, WHO has emphasized the importance of primary
health care (PHC) for promoting and protecting population health.
[1] PHC is highlighted as the mechanism through which countries
can provide better health to persons, families and communities,
with greater equity and lower costs,[1,2] because it “brings promo-
tion and prevention, cure and care together in a safe, effective and
socially-productive way at the interface between the population and
the health system.”[2]

Colombi a is a culturally and ethnically diverse country with a
highly varied demographic and epidemiologic profi le, and an
increased burden of chronic non-communicable diseases in the
past decade without yet having eradicated infectious diseases.
[3–5] Until recently, Colombia’s health system favored develop-
ment of a hospital-based, curative health care model, oriented
toward highly specialized care (the system revolving around spe-
cialists) under a free-market model (with users seen as consum-
ers and with a variety of public and private insurers and service
providers) that generates inequities in fi nancing and limits ac-
cess to health care, patient-centered care and community-based
health improvements.[6]

In 2011, Law 1438 modifi ed Colombia’s health system, putting
PHC legally at the center of the system to address the country’s
health priorities, emphasizing:
• public health actions such as health promotion and disease pre-

• coordination of intersectoral actions;
• a culture of self-care;
• comprehensive health care involving individuals, families and

communities; and
• active community participation and local approaches to attaining

long-term, continuous and intercultural attributes of care.[7–9]

This article describes an intervention based on PHC and commu-
nity-oriented primary care (COPC) principles,[10] aimed at building

capacity for community participation to change population health
status in Colombian communities.

Purpose, rationale and participants The Citizenship for Healthy
Environments (CxES), a qualitative participatory action research
(PAR) project to build community capacity to infl uence health, was
carried out from January 2012 through June 2014 (30 months)
with organizations in Bogotá and Cundinamarca, Colombia. In al-
liance with several institutions (Corona Foundation, Universidad
de La Sabana, Organization for Excellence in Health, Community
Development Consortium and Social Foundation) the authors in-
vited several community organizations to become part of a joint

The rationale for CxES was that implementation of PHC initiatives
aimed at solving priority health needs requires the integration of
multiple actors (decision makers, health institutions, academia, hu-
man resources in health