# Introduction he Organization for Cooperation and Economic Development (OECD) is comprised of 34 countries around the world. Since 2010 Colombia has shown its intention to enter the OECD, with a formal request by President Santos and followed by a visit to the OECD. Admission to the OECD will allow the country to benefit from the work and experience in the formulation of public policy of the leading economies in the world (Ministerio Hacienda, 2012). The Colombian Government will also have the opportunity to influence the design and adjustments of key instruments and initiatives to improve the functioning of the global economy and global governance (Gurria, 2013). OECD believes that the inclusion of Colombia is more a process than an event (OCDE, 2012) and as part of the process; the OECD will evaluate the application by Colombia of policies, practices and the legal instruments of the organization. The OECD's report, Health at Glance, 2013, showed improvement in life expectancy and infant mortality, however inequalities in wealth, education and other social indicators still have a significant impact on health status (OCDE, 2013). Colombia and the OECD countries share common challenges such as the ageing of the population, an increase of non-communicable diseases, users who expect better treatments, and the exponential increase of health technology and pharmaceuticals. In some indicators Colombia has a lot to learn and work on to reach the average OECD level and in others Colombia has lessons learned to share with the OECD. The goal of this analysis is to compare Colombian and OECD indicators, taking in account not only the average results, but the differences according to regions, ethnicity and income. Some of the data from the individual report providing health services has a 50% of under-reporting (ONS, 2014). # II. # Methodology We use the oecd framework with a broad view of public health including determinants of health and the OECD health care quality indicators project (kelley, 2006). we follow the same components of the OECD health analysis (OCDE, 2013), including health status, non-medical determinants of health, health workforce, health care, quality of care, access to care, health expenditure, ageing and long-term care. The figures and data from the oecd were taken from its public data base (OCDE, 2015). the colombian indicators were taken from official government data from the ministry of health, the national health institute and the national statistics department. the oecd and colombian average data is un-weighted, unless otherwise specified. also, we used data from international institutions such as the world bank, cepal, and the international development bank. some definitions have been taken from the world bank such as, middle-income economies described as those with a gni per capita of more than $1,045 but less than $12,746 (world bank, 2015). Indicators were evaluated according to methodology and scope in order to determine comparability with the indicators presented by the oecd report. we selected indicators including variables such as income and gender, using the free access databases of the OECD, attributing copyright ownership and adding colombian official data. most of the indicators used were from 2011 or the closest available year. Some of the OECD indicators have no corresponding official data from colombia but in each of # III. # Results # a) Health Status OECD and colombia have been showing a tendency to increase the life expectancy, but the methodology used to measure it varies between countries. life expectancy has a tendency to rise in both the OECD countries and colombia; however the methodology varies between countries. Women in all countries had a higher life expectancy than men. women showed better results all the countries. Life expectancy in colombia has increased from 64.7 (men) and 71.51 (women) in 1985 to 72.1 (men), 78.5 (women) in 2015. (ministerio de salud , 2013.) life expectancy in colombia is 4.2 years less than the average oecd countries. The life expectancy is 6 to 8 years higher among women though the difference between men and women could be reduced by 4 to 5 years by reducing deaths due to violence (ons, 2014). colombia has one of the highest homicide rate in the world 42.5 per 100 000 people in 2009, but is reducing compare with 65.8 in 1999, meanwhile salvador is increasing from 44,9 in 1999 to 62,9 in 2009 (ons, 2014). Colombia has important difference in life expectancy between regions being the highest in the capital (75.94 for men and 80.19 for women, and the lowest life expectancies concentrated in eight regions where life expectancy is less than 70 years: Chocó, Caquetá, Putumayo, Arauca, Casanare, Cauca, Meta and Amazonia) (Ministerio de ). There is no information relating life expectancy to level of education in Colombia. Colombia has higher infant mortality rate compared with the OECD average (12.8 Vs 4.1), similar to China (12.6) and lower than Brazil (13.9). Many countries have reduced infant mortality in the past decades; Mexico reduced infant mortality from 77 in 1970 to 17 in 2010 and Colombia from 40 to 12.8 in the same period. In some large non-member countries (India, South Africa and Indonesia), infant mortality rates remain above 20 deaths per 1,000 live births (OECD, 2013). In Colombia, between 2005 and 2011, the main causes of death in the general population were circulatory system diseases, though there has been a decline of this cause (from an adjusted rate of 166.43 to 146.16 deaths per 100,000 habitants). Cancer and external causes were the second and third cause of death, accounting for 17.42% (237,930) and 17.33% (236,679) of total deaths respectively from this period (Minsalud, 2013). Mortality due to circulatory system diseases was 132.2 per 100000 inhabitants, ischemic disease, 263.7 per 100000 inhabitants, and cerebrovascular disease was 130.0 per 100000 inhabitants (PAHO, 2010). This mortality is higher than the OECD average (122), similar to Iceland (133), lower than Hungary (309) and higher than Chile (70). The average cancer mortality rate across OECD countries was 211 per 100,000 population in 2011, and the most recent data in Colombia, from 2009, was 120 per 100,000 population, lower than Mexico 138.1 and Brazil 2011, however the WHO has been estimated an under-reporting of 24% (PAHO, 2011) which would bring this rate to approximately 149 per 100,000 population. Suicide rates were 5.0 deaths per 100, 000 inhabitants in Colombia (PAHO, 2010), similar to Greece, Turkey, Mexico, Brazil and Italy. In Korea, Hungary, the Russian Federation and Japan, suicide is responsible for more than 20 deaths per 100,000 people. Fatalities due to car accidents in Colombia were 13,2 deaths per 100,000 lower than Mexico and Chile or Brazil and higher than Sweden, the United Kingdom and Denmark with four deaths or less per 100,000 people (Cendex, 2008). 6.8% of all newborns weighed less than 2,500 grams at birth. The proportion of low-weight births was the lowest in Nordic countries and Estonia, with less than 5% of live births defined as low birth weight. Colombia is showing an increasing tendency in the number of low-weight births, reaching 9,1 in 2010 (INS, 2014). In almost all OECD countries, a majority of the adult population report their health as good. According to the health survey in Colombia, 72.2% reported their health as good (Rodriguez 2009). In Colombia diabetes affects 5.2% of the population (Vargas 2011). Diabetes affected an average 6.9% of the OECD population aged 20-79 years, in Mexico, more than 15% of adults have diabetes, but only 5% of adults suffer from diabetes in Belgium, Iceland, Luxembourg, Norway and Sweden. # b) Non-medical Determinants of Health In Colombia, current smoking in teenagers between the ages of 11 and 18 (prevalence in the last month) is 9.78%. Smoking among teenagers was 25% in Austria, the Czech Republic, and Hungary and less than 10% in Canada, Iceland, Norway, and the United States. (Cumsille, 2011) Drunkenness is reported to have been experienced at least twice by more than 40% of 15-yearolds in the Czech Republic, Denmark, Estonia, Finland, Hungary, Slovenia and the United Kingdom. In Colombia, 40% students between the ages of 11 and 18 year-old reported alcohol consumption in the past month, but no data about Drunkenness was found. (Cumsille, 2011) Overweight (including obesity) rates are approximately 23% for boys and 21% for girls, on average, in OECD countries. In Colombia it is 20.2% for overweight and 5.2% for obesity for boys and girls (Fonseca, 2011). Daily vegetable consumption was reported to be around 33% in girls and 25% in boys on OECD countries and only 13.5% in Colombia for boys and girls. In OECD countries, less than 25% of the children reported regular training with moderate-tovigorous exercise. Austria, Ireland, Spain, and Finland stand out as strong performers with over 30% of children reporting exercising for at least 60 minutes per day over the past week. In Colombia this figure was only 15% (Piñeros, 2010). Vegetable consumption were less than 15% in India, South Africa, and Brazil. In Colombia 12,8%, similar to Sweden, Iceland and the United States and lower than the average OECD consumption (20%) (Rodriguez, 2009) Alcohol consumption, as measured by annual sales, stands on average at 9.4 liters per adult per year across OECD countries and Colombia is 6,3 liters per adult per year higher than Costa Rica (3,9), Peru (3,7) y El Salvador (2,6) and lower than Mexico (8.9) (Sojo, 2012 ). 52.6% of the adult population in the OECD countries are reported as being overweight or obese. In Colombia 34.6% is overweight, including 16.5% obese (Fonseca, 2011). Obesity rates meanwhile vary widely in OECD countries from 4% in Japan and Korea, to over 32% in Mexico and the United States. The average vegetable intake across OECD countries was 64% for men and 73% for women while in Colombia it was only 19.6% per day (Fonseca, 2011). # c) Health workforce The rate of doctors per 1 000 inhabitants in Colombia is 2, similar to Korea and lower than Greece with 6.1 doctors per 1 000 Inhabitants. Colombia has 13 obstetricians per 100 000 people (Cendex, 2008), lower than all the OECD countries. There are 3 psychiatrists per 100,000 (Rosselli, 2001), compared with 15.6 psychiatrists per 100 000 inhabitants on average across OECD countries, so Colombia has a lower number of mental health professionals. There were two specialists for every generalist on average across the OECD countries in 2011. The slow growth in, or reduction of, the number of generalists raises concerns about access to primary care. In Colombia there is 1 specialist for every 10 generalists (Cendex, 2008), which would be impressive if it were not for the lack of empowerment of generalists to resolve most primary healthcare issues. The healthcare model continues to be based on specialists with poor implementation of primary health care. # Health care activity The number of appointments per person ranged from over 13 in Korea and Japan, and over 11 in Hungary, the Czech Republic and the Slovak Republic, to three or fewer in Mexico, Sweden, South Africa and Brazil. In Colombia 71% of the population had at least one appointment in 2011, and the average was 1.5 appointments per person (ONS, 2011). Japan and Korea had over nine hospital beds per 1000 people in 2011 while the average in OECD countries is 5. Colombia has 1.5 beds per 1,000 inhabitants (World Bank, 2012). The hospital stay was on average 4.5 days in OECD countries and in Colombia 3.3 (Ministry of Health, 2005). In 2011, caesarean section rates were lowest in Nordic countries and the Netherlands, with rates ranging from 15% to 17% of all live births. Caesarean section rates were highest in Mexico and Turkey (over 45%), followed by Chile, Italy, Portugal and Korea (with rates ranging between 35% and 38%). Colombia had a dramatic increase in the number of Caesarean sections with 4.9% in 1998 soaring to 45.7% in 2013 (Rubio, 2014). In Portugal, the generic market grew from virtually zero in 2000 to 30% in volume in 2011 and in Spain it grew up to 34%. In Colombia generics represented 17% in 2010 and has not shown a significant increase from 14% in 2007. (Econometría, 2011) d) Quality of Care Acute myocardial infarction mortality was low in Denmark (3%) while the highest rate is in Mexico (27%). In Colombia the mortality was 6,7% in 2005 (SILVA, 2006). Colombia reported an IMM rate of 60.9 per 100,000 in women and 93.4 per 100.000 in men showing a small reduction in comparison with 67.1 and 89.1 in 1990 respectively. (Revista Colombiana de Cardiología, 2010) Across OECD countries, 8.5% of patients died within 30 days in the same hospital in which the initial admission for ischemic stroke occurred. The casefatality rates were highest in Mexico (19.6%), Slovenia (12.8%) and Turkey (11.8%). Rates were less than 5% in Japan, Korea, Denmark and the United States. In Colombia this rate was 14%. (Zarruk, 2007) Screening rates for cervical cancer range from 15.5% in Turkey to 85.0% in the United States. Austria, Germany, Sweden, Norway and New Zealand also achieved coverage above 75%. In Colombia 76,5% of the women are screened for cervical cancer. (Piñeros, 2007) On average, in the OECD countries, 96% of children receive the recommended DTP vaccination and 94% receive measles vaccinations. Rates for DTP and/or measles vaccinations are below 90% only in Austria, Denmark, France, and South Africa. In Colombia the coverage is 93.5% (Minsalud, 2013), but some regions like San Andres have 62% coverage and Caldas 64% coverage, again exposing great differences e) Access to care Two OECD countries do not have universal health coverage. Mexico had 90% of the population covered and in the USA, 53% of the population is covered. Colombia reported 96% coverage in 2013; however this is not necessary equivalent to access to care. (Minsalud, 2014) The number of doctors per capita varies widely across regions within the same country. A common feature in many countries is the trend for physicians to concentrate in capital cities. In Colombia, in cities with populations less than 20 000 don't reach 0.4 doctors per 10,000 inhabitants while in large cities it is 10 per 10,000. The use of medical services in Colombia is lower among the poor population, at 34%, compared with 47% among the non-poor (Profamilia, 2010). In Colombia, the risk factors for the omission of cervical cancer screening include no insurance, affiliation to the subsidized healthcare regimen and low educational level. (Piñeros 2007) In breast cancer the risk factors were similar (De Charry, 2008). Incomerelated inequalities in cervical cancer screening are significant in 15 of the 16 countries in the OECD. f) Health expenditure and financing Colombia had the lowest expenditure compared with the OECD, with $466 USD Purchasing power parity (PPPs) compared with $ 3322 USD on average in the OECD , lower than Mexico ($977) or South Africa ($942). This expenditure is decreasing in countries such as Greece (-11.1) or Ireland (-6.6) and is increasing in countries such as Chile (9.3) and Colombia (World Bank, 2013). In Colombia, total healthcare expenditure expressed as a percentage with respect to the GDP represents 6.5% for 2011, with a range from 5.4% in 2004 to 7.0% in 2009. The government's general expenditure as a percentage of GDP represents an average of 4.7%, Private expenditure as a percentage of GDP represents an average of 1.7% and the out-ofpocket expenditure 1.1%, representing 17% of the expenditures (Minsalud, 2014). Healthcare spending accounted for 9.3% of the GDP on average across OECD countries in 2011, compared with 9.4% in 2010. g) Ageing and long-term care On average across OECD countries, 4% of the population was 80 years old and over in 2010. By 2050, the percentage will increase to 10%. In Colombia, this population represented 1.4% of the total population in 2011 and will increase up to 1.5 % in 2020. In Finland, France, Germany, Greece and Spain, only 35% to 40% of people aged 65 years and over rate their health as good. In Colombia 53.2% of by zone. The Human Papiloma Virus vaccine had 92% coverage for the second doses (Minsalud, 2013). people between 55 to 69 reported their health to be good (Profamilia, 2010 ). France, Italy, Switzerland, Spain, Sweden and Norway had the highest prevalence rate of dementia, with 6.3% to 6.5% of the population aged 60 years. In Colombia 1.8% of 65 years old and 3.4% of 75 years old suffer of dementia. On average across OECD countries, over 15% of people aged 50 and over provided care for a dependent relative or friend in 2010. Colombia has not comparable data, but 10.1% the population is define as disabled and among them 97% has been taken care by one member of the family (Urquieta, 2008). IV. # Discussion The main achievements of Colombia compared with OECD countries are universal coverage and low out-of-pocket payments. Colombia has some opportunities to show better health indicators due to a younger population, lower rates of diabetes and overweight and a low suicide rate compared with OECD countries. Colombia needs to improve on equality by region, education and income, plus needs to reduce preventable mortality due to violence. Similar studies were performed in some Latin American countries, such as as Chile and Mexico now members of the OECD. In one study from 2013, a comparison was taken from the health indicators in Chile with regard to those countries members of OECD; these studies yielded comparative data with higher indices in diabetes, obesity and suicide in comparison to countries from OECD being 6.9, 17.6 and 12.4 respectively. In addition, a greater out-of-pocket expenditure in health with 4.6% compared with the general average located at 2,86% (Ministerio de Salud Chile, 2013). Studies conducted in Mexico also demonstrate that diseases like diabetes have a higher prevalence, 10.8, compared with countries from the OECD which have 6.5, and with regard to obesity, countries from the OECD have rates of 16.9% while Mexico is 30%. With regard to total health expenditure, the country uses 6.4 % of PIB, well below countries from the OECD with 9.6 (Universidad de Mexico, 2013). Comparing health expenditure by GDP, countries like Colombia and Mexico are situated at an intermediate level with 500 to 900 dollars per capita annually and Brazil, Costa Rica and Chile in the superior level, with more than one thousand dollars per capita annually (Castro, 2012). Latin American countries with incomes similar to Colombia; like Peru, a country with a per capita income of 6,661.6 (Banco Mundial, 2013-2014), showed the health expenditure per capita for Colombia was a little higher (617.89) than Peru 496.16 according to the Center for National Development Planning of Peru,. With regard to external resources (services offered by international organizations) Colombia received 09% in 2011 while Peru almost doubled that amount with 1.5% (Ceplan, 2014). Some limitations to be considered in this work may be the result of not utilizing the same tools to measure indicators as well as the absence of data. In addition there is significant under-reporting especially from certain regions of Colombia. Finally, after assembling information regarding the health situation in Colombia, we suggest it is important to advance in quality topics and health service access, in addition to the use of family members as caregivers for the elderly. Last of all, health inequality in the different areas of the country is to be highlighted. # Volume XV Issue 2 Version I ![has been possible to identify some indicators.](image-2.png "") © 2015 Global Journals Inc. (US) ## Author's Participation The Authors Have Been Involved In The Data Collection, Analysis, Writing And Correction Of This Paper. ## Conflict Of Interest Statement The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest the subject matter or materials discussed in this manuscript. ## Funding The article analysis has no external funding. ## Ethical Consideration This article use secondary data and does not imply any kind of intervention with people and according to the helsinki declaration has no risk. ## V. acknowledgements The authors acknowledge the oecd for their generosity in providing free access to their data base and analysis. special thanks to ian forde and rodrigo moreno for their visit to colombia as part of the OECD health committee. * .PibBanco Mundial 2014. January 1. February 28. 2015 * Salud Y Seguridad Social: Un Breve Comparativo De Cinco Países De América Latina CCastro 2012. July 1. February 27, 2015 * Carga De Enfermedad Colombia Cendex Resultados Alcanzados Bogotá Pontificia Universidad Javeriana 2008. 2005 * Centro Nacional De PlaneamientoEstratégico El Perù En Los Indicadres Mundiales. Retrievedfebruary 27 Ceplan 2014. January 1. 2015 * Equidad En La Detección Del Cáncer De Seno En Colombia LDe Charry GCarrasquilla SRoca Revista Salud Pública 2008 * Co/Politicas%20Farmaceuticas/Pol% C3%Adtica%20farmac%C3%A9utica/Documentos% 20soporte/Diagnostico%20Situaci%C3%B3n%20Far mac%C3%A9utica%20Nacional%202011 Econometria UsoDiagnóstico De La Situación Actual Del Acceso Racional Y Calidad De Medicamentos Pdf 2011 * Encuesta Nacional De La Situación Nutricional En Colombia ZFonseca AHeredia POcampo YForero OSarmiento MÁlvarez ..Rodríguez M Da Vinci Editores & CÍA 2011. 2010 Bogotá * Lanzamiento Del Proceso De Adhesión De Colombia A La OCDE AGurria -Secretary-General Oecd //Www. Oecd.Org/About/Secretary-General/Lanzamiento-Del-Proceso-De-Adhesion-De-Colombia-A-La-Ocde.Htm March 10. 2015 * Bajo Peso Al Nacer A Término 2014. June 11. March 4, 2015 Instituto Nacional De Salud (INS Retrieved * Accion/Subdireccion-Vigilancia/Sivigila/Protocolos SIVIGILA/PRO Bajo Peso Al Nacer A Termino Pdf * Health Care Quality Indicators Project EKelley JHurst 2006 * Www 440 * MinisterioDe Salud N.D. ASIS 24022014.Pdf. 2013. March 10. 2015 * MinisterioDe Salud De Chile Panorama De Salud 4 2013. 2013. January 1. 2015 * Cifras Financieras Del Sector Salud: Gasto En Salud De Colombia Minsalud 2014. 2004-2011 Minsalud Bogotá * Retrieved From Http://Www.Minhacienda MinisterioHacienda nhacienda/2012/DECRETO%201192%20DE%2005- JUNIO-2012 Pdf 16. OECD. Ocde Establece Hoja De Ruta Para Adhesión De Colombia. (N.D.). 2013. March 10. 2015 * Health At A Glance //Www.Oecd-Ilibrary.Org March 10. 2015. 2013. 2013 OECD Publishing At-A-Glance-2013_Health_Glance-2013-En * Tomado De: Http://Www.Ins. Gov.Co/ Lineas-De-Accion/Ons/Siteassets/Paginas/Publica ciones/Informe4to-ONS-Fe25 Ons Violencia 2014. January 1 Pdf Homicida En Colombia * Indicadores Básicos 2010: Situación De Salud En Colombia Paho 2010 Ministerio De La Protección Social Bogotá * Actividad Física En Adolescentes De Cinco Ciudades Colombianas: Resultados De La Encuesta Mundial De Salud A Escolares Paho. ; M CPardo Htm 23. Piñeros 2011. March 10. 2015. 2010 From Http:// Ww w.Col.Ops-Oms.Org/Sivigila/Mortalidad/Indice * Cobertura De La Citología De Cuello Uterino Y Factores Relacionados En Colombia MPiñeros RCendales RMurillo CWeisner STovar Profamilia. ENCUESTA NACIONAL DE DEMOGRAFÍA Y SALUD 25 2007. 2005. 2010 Revista Salud Pública * Pro familia.Org.Co/Encuestas/Profamilia/Prof amilia/Index Www Php?Option=Com_Content&View=Arti * Revista Colombiana De Cardiología Revista Colombiana De Cardiología. Guías Colombianas De Cardiología Síndrome Coronario Agudo Con Elevación Del St. 17 2010 * JRodriguez FRuíz EPeñaloza JEslava LGómez HSánchez 2009 Bolivia, Y. * Encuesta Nacional DeSalud Resultados Nacionales. Bogotá: Fundación Cultural Javeriana De Artes Gráficas 2007 * Estimación De Laoferta De Médicos Especialistas En Colombia Con El Método De Captura-Recaptura DRosselli AOtero DHeller CCalderón SMoreno APérez Revista Panamericana De Salud Pública 2001 * Racionalización Del Uso De La Cesárea En Colombia JARubio-Romero JEFonseca-Pérez SMolina MBuitrago Leal JJZuleta EÁngel-Müller Others Rev. Colomb. Obstet. Ginecol Consenso De La Federación Colombiana De Obstetricia Y Ginecología (FECOLSOG) Y La Federación Colombiana De Perinatología (FECOPEN 65 2 2014. 2014 * Enfermedad Cerebrovascular En Colombia Federico A EtSilva Al Rev. Col. Cardiol 13 2 2006 Cited 2015-03-10 * Patrones De Consumo De Alcohol En América Latina CSojo Análisis Comparado De 9 2012 * FlacsoPaíses Costa Rica * JEUrquieta-Salomón JLFigueroa BHernández-Prado Retrievedmarch 3 El Gasto En Salud Relacionado Con La Condición De Discapacidad 2013. January 1. 2015. 2008 50 Universidad Nacional Autónoma De México La Salud En Mexico En Perpectiva Comparada. ; Un Análisis En Población Pobre De México. Salud Pública De México * Epidemiología De La Diabetes Mellitus. En A. C. Endocrinología, Fascículos De Endocrinología: Fascículos Diabetes (Págs HVargas Comité Editorial Fascículo Diabetes 2011 * Country And Lending Groups | Data Org/About/Country-And-Lending-Groups March 10. 2015 World Bank * Factors Associated To Mortality Alter 30 Days, In A Group Of Patients With Cerebro-Vascular Ischemic Disease (Stroke) JGZarruk FASilva PCamacho López WBorda JRestrepo OBernal ACórdoba Acta Medica Colombiana 32 1 2007 * Estudio nacional de consumo de sustancias psicoactivas en población escolar. Bogotá: Oficina de las Naciones Unidas contra la Droga y el Delito en Colombia FCumsille JFagua OScopetta 2011