For The Right To Life Of Children With Cancer In Colombia

Original Language Title: Por el derecho a la vida de los niños con cáncer en Colombia

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ACT 1388 2010
(May 26)
Official Gazette No. 47721 of May 26, 2010

CONGRESS OF THE REPUBLIC For the right to life of children with cancer in Colombia. Effective Jurisprudence



THE CONGRESS OF COLOMBIA DECREES: CHAPTER I.

OBJECT, DEFINITIONS, BENEFICIARIES INTEGRAL ATTENTION MODEL AND INSURERS.
ARTICLE 1o. PURPOSE OF THE LAW. Significantly decrease the rate of cancer mortality in children and people under 18, through the guarantee by the actors of the social security health of all services required for early detection and treatment comprehensive, implementation of standardized protocols and guidelines care and infrastructure, staffing, human resources and technology required in specialized centers authorized for that purpose.
PARÁGRAFO. The Ministry of Social Protection with the assistance of the National Cancer Institute and the Colombian Association of Pediatric Hematology and Oncology (ACHOP) design, update and / or improve, according to the technical annex to this law, the essential requirements of the Centers Attention, protocols and guidelines for the most common causes of childhood cancer in Colombia, within a maximum period of 12 months.
Article 2.
. BENEFICIARIES. The beneficiaries of this law:
1. The population under 18 years who has been confirmed through relevant studies, the diagnosis of cancer at any stage, types or modalities, certified by the Onco-hematology Pediatric duly accredited for the exercise of their profession according to the current regulations and the technical annex.
2. The population under 18 years with diagnosis confirmed and certified by the Paediatric Onco-hematology aplasias Failure Syndromes Spinal Cord and Spinal Cord, Hereditary Hemorrhagic Disorders, Hematologic Diseases Congenital, histiocytosis and histiocytic disorders
3. The population under 18 years when the general practitioner or any medicine specialist, has suspected cancer or diseases set out in paragraph 2 of this Article and examinations and specialized procedures are required, until the diagnosis is not ruled out.
PARÁGRAFO. When the attending physician, regardless of specialty, assume the existence of cancer or conditions mentioned in paragraph 2 of this Article shall refer the patient to the unit corresponding to the zone cancer, without prejudice to sort all examinations support and specialized diagnostic procedures considered necessary until the diagnosis is ruled out.

ARTICLE 3. WARRANTY OF CARE. The Ministry of Social Protection, within a period of 6 months shall regulate the creation and implementation of a database for agility care of the child with cancer.
So the doctor who is the presumptive diagnosis of cancer in a minor beneficiary of this law, included in this database, which can be consulted in real time and that will allow the EPS, ARS or Territorial entity in charge, according to the schemes of social health security force in the country, find the patient in the system.
In this database it will specify each beneficiary of this law, will, from that time until the diagnosis is not dismissed, with the approval of all procedures, comprehensive and immediately.
PARÁGRAFO. These procedures will be understood as all items and services required for the care of the beneficiaries of this law as office visits, diagnostic tests support, medications, surgery and follow-up the patient.
All procedures will have an equivalent management services included in the Mandatory Health Plan, POS, by the insurer or local authority.
If the patient belongs to the group of so-called linked to the social security system in health, will be enrolled immediately, a Health Promoting Company of this regime. If this is not possible, for whatever reason, will continue to receive this comprehensive care by the local authority.


ARTICLE 4. INTEGRAL ATTENTION MODEL. From confirmation of cancer diagnosis and treatment until the end, insurers authorize all services required by the child, immediately. These services will be provided in Unit Care of Childhood Cancer, according to the judgment of the treating physicians in different specialties, respecting the times, for confirmation of diagnosis and initiation of treatment to establish guidelines care, regardless of the themselves, have a direct relationship with the main disease or corresponding to other levels of complexity in models of care insurers.
If the unit does not have this service or not have the available capacity will be sent to this center point, without it being a limitation, payment of co-pays or prorated fees or waiting periods, regardless of the number of listed weeks.
When the child would be transferred to another unit Childhood Cancer, this shall be coordinated between the remitter and recipient entity, or the local authority and the EPS, must first provide all the information necessary for the treatment of minor continue without a hitch. PARAGRAPH 1.
. Will be the Children's Cancer Unit who provide high quality medicines, and whom the bill to the corresponding EPS, according to the requirements established by this. Likewise, the application of preventive treatments as Annual Influenza Vaccination should receive relatives and cohabitants of the child be guaranteed, which are provided in the Children's Cancer Unit, according to the guide of care and protocols; this in order to prevent the lack of these preventive measures, jeopardize the effectiveness of treatment of the child. PARAGRAPH 2.
. The insurer or the local authority, according to current regulations and those that define the Regulatory Health Commission, may reclaim the Solidarity Fund and Guarantee Fosyga, the value of services that are not included in its Plan of Benefits and which they have been supplied to lower cancer patient. In any case, the beneficiaries of this law, are not subject to waiting periods or Copayments or prorated fees. The Ministry of Social Protection regulate within 6 months, the procedure for making this recovery swiftly. PARAGRAPH 3.
. Any care or service made the child with cancer, will be supported in the protocols and care guidelines referred to in the first article of this law and the technical and annex as these are developed, in the discretion of the specialist responsible for processing .
PARÁGRAFO 4o. The insurer or the territorial entity that does not comply with the provisions of this article, retard, impede or hinder the child's immediate access to the services required, shall be punished with a fine of up to 200 SMMLV. Superintendent of Health and Departmental, District and Municipal Departments of Health, in exercise of its powers will be the entities responsible for the Inspection, Monitoring and Control.
CHAPTER II.
OF SERVICE.

The 5th ITEM. CARE UNITS OF CHILDHOOD CANCER (UACAI). From the entry into force of this Act, units Care of Childhood Cancer in Colombia, will be located in hospitals or clinics level III and IV of pediatric or pediatric ward level III or IV complexity and meet requirements of the Resolution 1043 of the Ministry of Social Protection, the Technical Annex, or other regulations to be issued designed to optimize the delivery of services to children with cancer. PARAGRAPH 1.
. The Ministry of Social Protection is responsible for the care sectorizar taking into account the needs of demand for its geographical location is rational. PARAGRAPH 2.
. The Ministry of Social Protection within a maximum period of 6 months shall regulate the essential requirements of the Care Units Children's Cancer and the number of units for territorial entity, in accordance with demand, with the assistance of the National Institute of cancer and the Society of Pediatric Hematology and oncology, and such requirements will be required of all institutions providing health services who offer any service to children with cancer to respect this law.


ARTICLE 6o. TIME LIMITS TO MEET CONDITIONS BASIC CARE UNIT OF CHILDHOOD CANCER. The Service Institutions of Health, IPS, which comply with the provisions of this article, in the level of complexity, which currently are providing services to treat children with cancer, will have a maximum of two years to enable the requirements set out in the technical annex, taking into account the following priorities:
a) Immediate area bounded specific and exclusive to the Children's Cancer Unit, with dedicated staff. Minors will not be scattered throughout the Hospital both hospital wards and outpatient chemotherapy;
B) preparation of cytostatic Central, within a period of 12 months;
C) At 24 months the construction and architectural adaptation of the unit.
PARÁGRAFO. Within a maximum period of 6 months, the Ministry of Social Protection will review the economic feasibility of current fees cover infrastructure investment and staffing of the Unit of Childhood Cancer, in a maximum term of 10 years and propose to be the case, the necessary adjustments to the competent regulator.

ARTICLE 7. SUPPLY OF SERVICES. From the effective date of this law, the Underwriters the contributory scheme and subsidized health, have among their network of providers, Units Childhood Cancer of the areas or regions where they have beneficiaries in accordance with the availability and according with population parameters established by the technical annex and defining the Ministry of Social Protection.

Article 8. EARLY DIAGNOSIS AND TIMELY REFERRAL BY GENERAL MEDICAL OR OTHER SPECIALISTS. The general or specialist doctor (outside the unit of cancer, among other pathologists), must have guidelines that allow, without any delay, refer the child with a presumptive diagnosis of cancer, or diseases mentioned in the 2nd paragraph of Article 2rd this law, a Children's Cancer Unit, enabled or enabling process, the III or IV level of complexity, that will be practiced, timely, all the necessary tests designed to confirm or reject the diagnosis.
PARÁGRAFO. In a period of six (6) months from the enactment of this law, the Ministry of Social Protection draw up the guidelines in the preceding article refers to and promote training activities, as necessary, so that the doctor general and other specialists, can provide adequate and timely handling children who suffer or are suspected to suffer from any of the diseases contemplated by the present law.

Article 9. OPPORTUNITY AND EFFECTIVENESS OF CHILDREN WITH SIGNS HISTOPATHOLOGIC CANCER. From the entry into force of this Act and subject to the requirements presented in the technical annex and care guides, external to the Cancer Unit, pathologists must process the corresponding biopsy, a maximum of 7 days or less, according to the Guide for the Care and suspicion of cancer, should report to the Cancer Unit for patient location and registration in the system, also including the written report, the data for the location of patient and histologic sections or paraffin block from the original tumor.
PARÁGRAFO. Failure to comply with the provisions of this article shall be penalized under the terms established in the 4th paragraph of Article 4 of this law.

ARTICLE 10. COMMITTEE OF TUMORS. Since the management of a child with cancer imposes the need for a multidisciplinary and interdisciplinary work, from the entry into force of this Act, the Service Institutions of Health Care Units Childhood Cancer, disabled or in process habilitation, they will have a Tumor Committee for the purpose of developing a coordinating activity, control and counseling about the disease, within the IPS. The Committee shall have the functions included in the Technical Annex.

ARTICLE 11. NETWORK CARE UNITS CHILDHOOD CANCER. From the effective date of this law, the Units of child CA Attention enabled or enabling process in the country, will be organized in a virtual network, which also facilitate mutual support contributing to knowledge management, dissemination of good practices, studies and scientific research on diseases that treats this law, and others, according to the practice and development of medicine, come to belong to this group.

PARÁGRAFO. The Ministry of Social Protection, within a period of 6 months from the entry into force of this law, shall regulate the criteria for the creation of the Network of Cancer Care Units in the country.

Matches
CHAPTER III.
INFORMATION, REGISTRATION AND RESEARCH.

ARTICLE 12. NATIONAL REGISTRY OF CHILDHOOD CANCER. For the development of the security provided for in article 3 of this law, the National Childhood Cancer Registry is created, with the purpose of bringing real-time recording on the diagnosis, monitoring and evolution of patient treatment, with the information to quality care and scientific studies. The indispensable minimum information that must capture this system appears in the technical annex. This register will be part of SIVIGILA and will be notifiable in real time by the actors social security health, subject to optimize the data, according to the new information system which provides for the 1122 Law 2007.
PARAGRAPH 1.. Within a period not exceeding one year, the Ministry of Social Protection and the National Institute of Health, with the assistance of the Colombian Association of Pediatric Hematology and Oncology (ACHOP) and the Advisory Council on the subject, made the necessary adjustments the current SIVIGILA, for capturing, processing, archiving and retrieval of information of children with cancer.
This log will be filled in real time and will be a basic requirement for the legalization of the bill by the IPS of services provided, subject to the requirements of the standards. a single software mandatory adoption for Units will be developed and will be mandatory adoption by providers of these services. PARAGRAPH 2.
. The Ministry of Social Protection, within a period of 6 months shall regulate the creation and implementation of the database for agility care of the child with cancer to in the article 3 of this law. PARAGRAPH 3.
. Create the National Unique number for beneficiaries of this law. This unique number National will serve as a mechanism to record reliably, deaths, retirements and other information to facilitate monitoring of patients and conducting studies and research, according to methodology within a maximum period of one year to implement the Ministry of Social protection as part of the National Registry of Childhood Cancer.
CHAPTER IV.
INTEGRAL TO RETAIL SUPPORT CANCER.

ARTICLE 13. SOCIAL SUPPORT SERVICE. From the effective date of this law, the beneficiaries thereof, shall, when required treatment or diagnostic tests, to have the services of a home Paso, payment of the cost of travel, psychosocial support and school, according to their needs, certified by the Social Worker or Care Center responsible by the child. PARAGRAPH 1.
. Within a maximum period of six months, the Ministry of Social Protection shall regulate matters relating to the procedure and cost of support services, given that these will be free for the child and at least one relative or guardian, who will be his companion, during the practice of diagnostic tests support.
Treatment or administrative procedures, as well as the source to cover the same, based on the resources that do not run Fosyga or financial returns from it. PARAGRAPH 2.
. Within a maximum period of six (6) months, the Ministry of Education, regulate regards the special academic support in the institutions providing health services who offer any service to the beneficiaries of this law, so that absences school by reason of treatment and consequences of the disease, not significantly affect their academic performance. The Ministry of Education will also ensure that public and private schools to develop and fulfill a plan of emotional support to the beneficiaries of this law and their families.

ARTICLE 14. NATIONAL ADVISORY COUNCIL OF CHILDHOOD CANCER. Create the National Advisory Childhood Cancer Council as the body responsible for following up and monitoring the implementation of this law, as well as national policies and plans thereof arise, and propose, if necessary, adjustments as required.

The National Advisory Council shall consist of: The Minister of Social Welfare or his delegate, the Director of the National Cancer Institute, the president of the Colombian Association of Pediatric Hematology and Oncology, Director of the Colombian Institute of Family Welfare representative of EPS, representing the IPS, a representative of the non-profit organization or foundations dedicated to supporting children with cancer and a representative of parents.
PARÁGRAFO. The Advisory Council will among others, the following functions:
a) undertake monitoring and monitor the implementation of this Act;
B) advise the Ministry of Social Protection in the development of regulations derived from this law;
C) propose policies, plans and aimed at improving the comprehensive care of the child with cancer and lower rates of mortality in this population strategies;
D) propose the necessary adjustments to current regulations, including this Act;
E) Ensure the effectiveness of the National Information System;
F) Establish goals for continuous improvement in the management of Colombian children who suffer from cancer and who are beneficiaries of the law;
G) propose mechanisms and adjustments to improve comprehensive care model to lower cancer patient;
H) Establish priorities for studies and scientific research related to child CA;
I) analyze the evolution of indicators of Children CA, proposing goals in this regard;
J) Support the management of all types of resources to support child care with Cancer.
K) Advise necessity, the Ministry of Social Protection, the Health Regulatory Commission and other entities that require it, in terms of fees, costs, procedures and other issues to improve comprehensive care for children and young people, beneficiaries of this law;
L) Submit an annual report to Congress report, which will detail their work and activities;
M) will generate its rules of procedure. PARAGRAPH 2.
. At the end of the 6 months after the publication of this law, the Ministry of Social Protection regulate all matters concerning the National Council Advisors Infantil CA, the election of its members, the frequency of meetings and other aspects to ensure optimum performance.

ARTICLE 15. DEPARTMENTAL ADVISORY COUNCILS. In each department of Colombia, the Departmental Advisory Councils will be organized in child CA, as bodies supporting the implementation, monitoring and continuous improvement of this Act, consist of: The Departmental Secretary of Health, Education Secretary, Director of Unit Child CA enabled or enabling process in the Department, Chairman of Social Policy, director of ICBF, representative of a non-profit organization, representing EPS of jurisdiction, representative of parents and one representative community.
The Departmental Councils will assume the functions described in the previous paragraphs, within the scope and powers of the territory. PARAGRAPH 1.
. At the end of the 6 months after the publication of this law, the Ministry of Social Protection regulate all matters concerning the National and Departmental Advisory Councils Children's CA, the election of its members, the frequency of meetings and other aspects to ensure optimum performance. Final provisions


ARTICLE 16. EFFECTIVE DATE. This law governs from its sanction and publication, repealing all provisions which are contrary.
The President of the honorable Senate,
JAVIER CACERES LEAL.
The Secretary General of the honorable Senate,
EMILIO OTERO DAJUD.
The President of the honorable House of Representatives,
Edgar Alfonzo Gomez Roman.
The Secretary General of the honorable House of Representatives,
JESUS ​​ALFONSO RODRÍGUEZ CAMARGO.
REPUBLIC OF COLOMBIA - NATIONAL GOVERNMENT
published and enforced.
Given in Bogotá, DC, on May 26, 2010.

Alvaro Uribe Minister of Finance and Public Credit, Óscar Iván Zuluaga
ESCOBAR.
The Minister of Social Protection, Diego Palacio
. CONSTITUTIONAL COURT


General Secretariat Bogotá, DC, twenty-seven (27) April two thousand and ten (2010) Job
No CS-112

JAVIER CACERES LEAL President || | Senate
Reference: File OP-116 Judgment C-850/09. Bill number 2008 336 House, Senate 094 2007, for the right to life of children with cancer in Colombia. Nilson Pinilla Pinilla Magistrate.
Dear Dr.
:
politely and in accordance with Article 16 of Decree 2067 of 1991, I would send a copy of the Judgment C-850 of 2009 of twenty-five (25) November two thousand and nine (2009), proffered in the process of the reference.
At the same time, I refer the constant legislative dossier of 328 folios.
Yours sincerely, MARTHA
VICTORIA Sáchica MENDEZ, General Secretary
. Annex
copy of the judgment with 52 pages. CONSTITUTIONAL COURT


-Sala fully JUDGMENT C-850 2009
Reference: File OP-116.
Presidential Objections to the bill number 2007 094 Senate and 336 House 2008, for the right to life of children with cancer in Colombia.
Magistrate Nilson Pinilla Pinilla
Bogotá, DC, November 25 (25) two thousand and nine (2009).
The Plenum of the Constitutional Court, pursuant to its constitutional powers and the requirements and procedures established in Decree 2067 of 1991, has issued the following JUDGMENT
I
. BACKGROUND
an official letter received on 26 January 2009 at the General Secretariat of the Constitutional Court, the President of the Senate referred the bill number 2007 094 Senate and 336 House 2008, for the right to lives of children with cancer in Colombia, objected by the Executive on grounds of unconstitutionality, being filed as File OP-116.
In providence February 5 this year, he set list set in the matter and ordered officiate the Secretaries-General of the Senate and House of Representatives, to submit information on the event subject to trial constitutional. In communication
February 9 this year, the Chief of the Law of the Senate requested the return of the legislative record, on the grounds that "the process of adoption of the report of objections to the House of Representatives was pending ... "above" ... in order that the procedure is to take. "
By car February 18 this year, the Full Court of the corporation decided to refrain from deciding on the presidential objections to the bill reference and ordered to return to the Speaker of the House of Representatives legislative record to give effect to Article 167 of the Constitution.
With office April 3 cursante year, the President of the Senate of the Republic sent back the record of the bill, including the approval of the report on the objections in plenary session of the House of Representatives.
Fulfilled the mentioned process and received the concept of the Attorney General's Office, then this Court's ruling on the presidential objections.
II. TEXT OF BILL
The text of the bill contested by the Government is transcribed:
"Law No.
'for the right to life of children with cancer in Colombia' || | The Congress of Colombia DECREES
:
Object, definitions, comprehensive care model and insurers
Article 1. beneficiaries. Object of the law. Significantly decrease the rate of cancer mortality in children and people under 18, through the guarantee by the actors of the social security health of all services required for early detection and treatment comprehensive, implementation of standardized protocols and guidelines care and infrastructure, staffing, human resources and technology required in specialized centers authorized for that purpose.
Parágrafo. The Ministry of Social Protection with the assistance of the National Cancer Institute and the Colombian Association of Pediatric Hematology and Oncology (ACHOP) design, update and / or improve, according to the technical annex to this law, the essential requirements of the Centers Attention, protocols and guidelines for the most common causes of childhood cancer in Colombia, within a maximum period of 12 months. Article 2.
. Beneficiaries. The beneficiaries of this law:
1. The population under 18 years who has been confirmed through relevant studies, the diagnosis of cancer at any stage, types or modalities, certified by the Onco-hematology Pediatric duly accredited for the exercise of their profession according to the current regulations and the technical annex.
2. The population under 18 years confirmed and certified by the Paediatric Onco-hematology of aplasia Failure Syndromes Spinal Cord and Spinal Cord, Hereditary Hemorrhagic Disorders, Hematologic Diseases Congenital, histiocytosis and histiocytic disorders diagnosis

3. The population under 18 years when the general practitioner or any medicine specialist, has suspected cancer or diseases set out in paragraph 2 of this Article and examinations and specialized procedures are required, until the diagnosis is not ruled out.
Parágrafo. When the attending physician, regardless of specialty, assume the existence of cancer or conditions mentioned in paragraph 2 of this Article shall refer the patient to the unit corresponding to the zone cancer, without prejudice to sort all examinations support and specialized diagnostic procedures considered necessary until the diagnosis is ruled out.
Article 3o. Guarantee of care. The Ministry of Social Protection, within a period of 6 months shall regulate the creation and implementation of a database for agility care of the child with cancer.
So the doctor who is the presumptive diagnosis of cancer in a minor beneficiary of this law, included in this database, which can be consulted in real time and that will allow the EPS, ARS or Territorial entity in charge, according to the schemes of the Social Security Health force in the country, find the patient in the system.
In this database it will specify each beneficiary of this law, will, from that time until the diagnosis is not dismissed, with the approval of all procedures, comprehensive and immediately.
Parágrafo. These procedures will be understood as all items and services required for the care of the beneficiaries of this law as office visits, diagnostic tests support, medications, surgery and follow-up the patient.
All procedures will have an equivalent management services included in the Mandatory Health Plan, POS, by the insurer or local authority.
If the patient belongs to the group of so-called linked to the Social Security System in Health, will be enrolled immediately, a Health Promoting Company of this regime. If this is not possible, for whatever reason, will continue to receive this comprehensive care by the local authority.
Article 4o. Comprehensive Care Model. From confirmation of cancer diagnosis and treatment until the end, insurers authorize all services required by the child, immediately. These services were provided in Unit Care of Childhood Cancer, according to the judgment of the treating physicians in different specialties, respecting the times, for confirmation of diagnosis and initiation of treatment to establish guidelines care, regardless of the themselves, have a direct relationship with the main disease or corresponding to other levels of complexity in models of care insurers.
If the unit does not have this service or not have the available capacity will be sent to this center point, without it being a limitation, payment of co-pays or prorated fees or waiting periods, regardless of the number of listed weeks.
When the child would be transferred to another unit Childhood Cancer, this shall be coordinated between the remitter and recipient entity, or the local authority and the EPS, must first provide all the information necessary for the treatment of minor continue without a hitch.
Paragraph 1o. Will be the Children's Cancer Unit who provide high quality medicines, and who billed the corresponding EPS, according to the requirements established by this. Likewise, the application of preventive treatments as Annual Influenza Vaccination should receive relatives and cohabitants of the child be guaranteed, which are provided in the Children's Cancer Unit, according to the guide of care and protocols; this in order to prevent the lack of these preventive measures, jeopardize the effectiveness of treatment of the child.
Paragraph 2o. The insurer or the local authority, according to current regulations and those that define the Regulatory Health Commission, may reclaim the Solidarity Fund and Guarantee Fosyga, the value of services that are not included in its Plan of Benefits and which they have been supplied to lower cancer patient. In any case, the beneficiaries of this law, are not subject to waiting periods or Copayments or prorated fees. The Ministry of Social Protection regulate within 6 months, the procedure for making this recovery swiftly.

Paragraph 3o. Any care or service made the child with cancer, will be supported in the protocols and care guidelines referred to article 1 of this law and the technical and annex as these are developed, in the discretion of the specialist responsible for processing .
Paragraph 4o. The insurer or the territorial entity that does not comply with the provisions of this article, retard, impede or hinder the child's immediate access to the services required, shall be punished with a fine of up to 200 SMMLV. Superintendent of Health and Departmental, District and Municipal Departments of Health, in exercise of its powers will be the entities responsible for the Inspection, Monitoring and Control. CHAPTER II

Of service providers
article 5. Care Units Childhood Cancer (UACAI). From the entry into force of this Act, units Care of Childhood Cancer in Colombia, will be located in hospitals or clinics level III and IV of pediatric or pediatric ward level III or IV complexity and meet requirements of the Resolution 1043 of the Ministry of Social Protection, the Technical Annex, or other regulations to be issued designed to optimize the delivery of services to children with cancer.
Paragraph 1o. The Ministry of Social Protection is responsible for the care sectorizar taking into account the needs of demand for its geographical location is rational.
Paragraph 2o. The Ministry of Social Protection within a maximum period of 6 months shall regulate the essential requirements of the Care Units Children's Cancer and the number of units for territorial entity, in accordance with demand, with the assistance of the National Institute of cancer and the Society of Pediatric Hematology and oncology, and such requirements will be required of all institutions providing health services who offer any service to children with cancer to respect this law.
Article 6o. Of Time to meet the basic conditions of the Unit for Childhood Cancer. The Service Institutions of Health, IPS, which comply with the provisions of this article, in the level of complexity, which currently are providing services to treat children with cancer, will have a maximum of two years to enable the requirements set out in the technical annex, taking into account the following priorities:
a) Immediate area bounded specific and exclusive to the Children's Cancer Unit, with dedicated staff. Minors will not be scattered throughout the Hospital both hospital wards and outpatient chemotherapy;
B) preparation of cytostatic Central, within a period of 12 months;
C) At 24 months the construction and architectural adaptation of the unit.
Parágrafo. Within a maximum period of 6 months, the Ministry of Social Protection will review the economic feasibility of current fees cover infrastructure investment and staffing of the Unit of Childhood Cancer, in a maximum term of 10 years and propose to be the case, the necessary adjustments to the competent regulator. Article 7.
. Bidding Services. From the effective date of this law, the Underwriters the contributory scheme and subsidized health, have among their network of providers, Units Childhood Cancer of the areas or regions where they have beneficiaries in accordance with the availability and according with population parameters established by the technical annex and defining the Ministry of Social Protection. Article 8.
. Timely diagnosis and early referral by General Practitioners or other specialists. The general or specialist doctor (outside the unit of cancer, among other pathologists), must have guidelines that allow, without any delay, refer the child with a presumptive diagnosis of cancer, or diseases mentioned in the 2nd paragraph of Article 2rd this law, a Children's Cancer Unit, enabled or enabling process, the III or IV level of complexity, that will be practiced, timely, all the necessary tests designed to confirm or reject the diagnosis.

Parágrafo. In a period of six (6) months from the enactment of this law, the Ministry of Social Protection draw up the guidelines in the preceding article refers to and promote training activities, as necessary, so that the doctor general and other specialists, can provide adequate and timely handling children who suffer or are suspected to suffer from any of the diseases contemplated by the present law. Article 9.
. Timeliness and effectiveness of the histopathological samples of children with cancer. From the entry into force of this Act and subject to the requirements presented in the technical annex and care guides, external to the Cancer Unit, pathologists must process the corresponding biopsy, a maximum of 7 days or less, according to the Guide for the Care and suspicion of cancer, should report to the Cancer Unit for patient location and registration in the system, also including the written report, the data for the location of patient and histologic sections or paraffin block from the original tumor.
Parágrafo. Failure to comply with the provisions of this article shall be penalized under the terms established in paragraph 4 of Article 4 of this law.
Article 10. Tumor Committee. Since the management of a child with cancer imposes the need for a multidisciplinary and interdisciplinary work, from the entry into force of this Act, the Service Institutions of Health Care Units Childhood Cancer, disabled or in process habilitation, they will have a Tumor Committee for the purpose of developing a coordinating activity, control and counseling about the disease, within the IPS. The Committee shall have the functions included in the Technical Annex.
Article 11. Units Network Childhood Cancer Care. From the effective date of this law, the Units of child CA Attention enabled or enabling process in the country, will be organized in a virtual network, which also facilitate mutual support contributing to knowledge management, dissemination of good practices, studies and scientific research on diseases that treats this law, and others, according to the practice and development of the medium, reaching belong to this group.
Parágrafo. The Ministry of Social Protection, within a period of 6 months from the entry into force of this law, shall regulate the criteria for the creation of the Network of Cancer Care Units in the country. CHAPTER III

of information, registration and investigation
Article 12. National Childhood Cancer Registry. For the development of the security provided for in article 3 of this law, the National Childhood Cancer Registry is created, with the purpose of bringing real-time recording on the diagnosis, monitoring and evolution of patient treatment, with the information to quality care and scientific studies. The indispensable minimum information that must capture this system appears in the technical annex. This register will be part of SIVIGILA and will be notifiable in real time by the actors social security health, subject to optimize the data, according to the new information system which provides for the 1122 Law 2007.
paragraph 1o. Within a period not exceeding one year, the Ministry of Social Protection and the National Institute of Health, with the assistance of the Colombian Association of Pediatric Hematology and Oncology (ACHOP) and the Advisory Council on the subject, made the necessary adjustments the current SIVIGILA, for capturing, processing, archiving and retrieval of information of children with cancer.
This log will be filled in real time and will be a basic requirement for the legalization of the bill by the IPS of services provided, subject to the requirements of the standards. a single software mandatory adoption for Units will be developed and will be mandatory adoption by providers of these services.
Paragraph 2o. The Ministry of Social Protection, within a period of 6 months shall regulate the creation and implementation of the database for agility care of the child with cancer to in the article 3 of this law.

Paragraph 3o. Create the National Unique number for beneficiaries of this law. This Unique National Number serve as a mechanism to record reliably, deaths, retirements and other information to facilitate monitoring of patients and conducting studies and research, according to methodology within a maximum period of one year to implement the Ministry of Social protection as part of the National Registry of Childhood Cancer. CHAPTER IV

the integral support the child with cancer
Article 13. Social Support Service. From the effective date of this law, the beneficiaries thereof, shall, when required treatment or diagnostic tests, to have the services of a home Paso, payment of the cost of travel, psychosocial support and school, according to their needs, certified by the Social Worker or Care Center responsible by the child.
Paragraph 1o. Within a maximum period of six months, the Ministry of Social Protection shall regulate matters relating to the procedure and cost of support services, given that these will be free for the child and at least one relative or guardian, who will be his companion, during the practice of diagnostic tests support.
Treatment or administrative procedures, as well as the source to cover the same, based on the resources that do not run Fosyga or financial returns from it.
Paragraph 2o. Within a maximum period of six (6) months, the Ministry of Education, regulate regards the special academic support in the institutions providing health services who offer any service to the beneficiaries of this law, so that absences school by reason of treatment and consequences of the disease, not significantly affect their academic performance. The Ministry of Education will also ensure that schools develop and fulfill a plan of emotional support to the beneficiaries of this law and their families.
Article 14. National Childhood Cancer Advisory Council. Create the National Advisory Childhood Cancer Council as the body responsible for following up and monitoring the implementation of this law, as well as national policies and plans thereof arise, and propose, if necessary, adjustments as required.
The National Advisory Council shall consist of: The Minister of Social Welfare or his delegate, the Director of the National Cancer Institute, the president of the Colombian Association of Pediatric Hematology and Oncology, Director of the Colombian Institute of Family Welfare representative of EPS, representing the IPS, a representative of the non-profit organization or foundations dedicated to supporting children with cancer and a representative of parents.
Parágrafo. The Advisory Council will among others, the following functions:
a) undertake monitoring and monitor the implementation of this Act;
B) advise the Ministry of Social Protection in the development of regulations derived from this law;
C) propose policies, plans and aimed at improving the comprehensive care of the child with cancer and lower rates of mortality in this population strategies;
D) propose the necessary adjustments to current regulations, including this Act;
E) Ensure the effectiveness of the national information system;
F) Establish goals for continuous improvement in the management of Colombian children who suffer from cancer and who are beneficiaries of the law;
G) propose mechanisms and adjustments to improve comprehensive care model to lower cancer patient;
H) Establish priorities for studies and scientific research related to child CA;
I) analyze the evolution of indicators of Children CA, proposing goals in this regard;
J) Support the management of all types of resources to support child care with Cancer;
K) Advise necessity, the Ministry of Social Protection, the Health Regulatory Commission and other entities that require it, in terms of fees, costs, procedures and other issues to improve comprehensive care for children and young people, beneficiaries of this law;
1) Submit an annual report to Congress report, which will detail their work and activities;
M) will generate its rules of procedure.

Paragraph 2o. At the end of the 6 months after the publication of this law, the Ministry of Social Protection regulate all matters concerning the National Council Advisors Infantil CA, the election of its members, the frequency of meetings and other aspects to ensure optimum performance.
Article 15. Departmental Advisory Councils. In each department of Colombia, the Departmental Advisory Councils will be organized in child CA, as bodies supporting the implementation, monitoring and continuous improvement of this Act, consist of: The Departmental Secretary of Health, Education Secretary, Director of Unit Child CA enabled or enabling process in the Department, Chairman of Social Policy, director of ICBF, representative of a non-profit organization, representing EPS of jurisdiction, representative of parents and one representative community.
The Departmental Councils will assume the functions described in the previous paragraphs, within the scope and powers of the territory.
Paragraph 1o. At the end of the 6 months after the publication of this law, the Ministry of Social Protection regulate all matters concerning the National and Departmental Advisory Councils Children's CA, the election of its members, the frequency of meetings and other aspects to ensure optimum performance.

Final Provisions Article 16. Validity. This law governs from its sanction and publication, repealing all provisions which are contrary. "
III. OBJECTIONS OF THE NATIONAL GOVERNMENT
For the Government the draft law challenged violates Article 152 of the Constitution, which mandates submit to the process of statutory law related to fundamental rights, it regulates the right to health of children suffering cancer, which express mandate of Article 44 of the Constitution and the jurisprudence of this Court (C-463 and T-760 of 2008), holds that character, not only for their connectedness with other rights of the same lineage, but by derive directly from the principle of universality of social security enshrined in Article 48 above.
It claims that the bill is contrary to the Constitution, because by setting restrictions that prevent the state overcome the flaws in the comprehensive and coordinated regulation of Social Security System in Health, directly affects the health rights and life and, in general, the rights of children. In this regard explains that the project interferes with the adoption of measures aimed at correcting the failures of regulation analyzed by the Court in the Judgment T-760 of 2008, which translates into an obstacle to guarantee the fundamental right to health and other related basic rights, as provided for in articles 11 and 44 above.
Considers that the correction of the regulatory measures should be fully analyzed from the universe of diseases that must be addressed, as well as from different groups and, in general, of all people, in addition to considerations of available resources, as highlighted by the Court in that ruling.
In this sense dictates that this Court for the provision of health services to the population must be a result of the adoption of a public health policy, taking into account global and comprehensive benefits that can be award, given limited resources, task for the Government, the National Council of Social Security in Health and Health Regulation Commission CRES, as provided by Law 1122 of 2007.
it states that the objection is not intended ignore the health protection of children, particularly those suffering from cancer, but make legislative activity is consistent with the comprehensive and universal character of this fundamental right, at its discretion, it can only be achieved through analysis part of the instances that have the information and are competent to define the scope and possibilities of the health system, which does not exclude the preparation and presentation by the National Government bills for this purpose.
States that public health policy can not be configured in a dispersed manner across different bills that regulate various pathologies will define the contents of the benefit plan, because it is a matter that requires prior analysis their relevance and integration into a system whose content should be defined based on the assessment and definition of a sustainable financing scheme in time to allow effective access to the benefits provided.

Regard, said that the legislature moved to head the National Council of Social Security in Health, and later head of the CRES by Law 1122 of 2007, the competence to define the contents of the Compulsory Health Plan and value of Capitation Payment Unit, in order to ensure the financial viability of such benefits.
In his view, the problem described is a current legislative practice and thus evidenced bills dealing with various contents and scope very broad or unlimited health, such as fetal alcoholism, sickle cell anemia, dwarfism, obesity, ocular prosthesis, epilepsy, vasectomy and tubal ligation, among others, currently make traffic in the Congress.
It states that the Council for Health and Social Security, at the time, for the CRES would be impossible the definition of comprehensive and sustainable health benefits, why it should be understood that for the determination of policy in that field they must concur harmoniously, according to their skills, different state bodies, including legislative, as a result of a previous, comprehensive analysis, to define clear limits to relevant benefits, in order to ensure its viability in depending on the resources available.
Argues that the Ministers of Social Welfare and Finance in communication sent to Congress during the processing of the bill, said that any pathology must have adequate and timely treatment in the General Social Security System, where provides for the care of children cancer; Likewise, they expressed that the definition of the contents of POS by legislation dismantles the system design created by the legislator, warning also that in recent years the General System of Social Security in Health shows an increase in the number of members thanks to the increased number of insured subsidized scheme, while the tax regime has remained almost stable, as corroborated by the study conducted in 2007 by the Corona Foundation, the University of the Andes, the National Planning Department and Universidad del Rosario.
Considers important to highlight the effort that involved the creation of the Health Regulation Commission, CRES, Law 1122 of 2007, as a technical agency to which you were entrusted with the task of defining and modifying Mandatory Health Plans ; define and review at least once a year, the list of essential drugs and generic that will be part of the benefit plans and define the value of Capitation Payment Unit of each scheme, among others.
States that in the aforementioned communication ministers also said that is not appropriate parcelar care of certain diseases and generate preferential treatment for some diseases or some sectors over others, because although this could be justified at the time of issue regulations in this field all sick or age group would claim by his clinging to his specialty, nature and conditions, among other reasons.
Reiterates that through initiatives such as the challenged, the General System of Health Social Security loses its general nature, to proliferate subsystems with special care schemes, losing interrelation the component parts and hence the Court in the said Judgment T-760 of 2008, has been ordered, inter alia, review the contents of the POS, update and unify the benefit plans for children Contributory Scheme and Subsidized, taking into account the financial sustainability and keeping head CRES expertise to define the contents of the POS, in harmony with the epidemiological needs of the population and the availability of resources.
Exposes the CNSSS currently conducts studies and analyzes to achieve the objectives stated by the Court, which requires review how to be integrated into the POS various diseases, including high cost, such as cancer, without prejudice to the financial sustainability of benefit plan that comes to pass.

Claims that as currently the General System of Health Social Security guarantees population access to cancer treatment, in terms of available resources in the country and in the same system for both the Contributory Scheme to Subsidized, it is necessary to review not only the expected benefits for the care of the disease, but those who are and / or will be granted to the attention of other pathologies, starting with those of the population under 12 years.
Considers appropriate for the legislature note that according to the guidelines of the Judgment T-760 of 2008, the CRES or, failing the CNSSS, competent to define coverage, viewing the overall picture of the system and the financial sustainability of the project, from the resources rationally be applied by the State and those with ability to pay, so the draft challenged law is not for the population which benefits by a factor of disarticulation against decisions pointing the sentence.
Another objection formulated by the Executive against the bill is that its processing article 7 of the Organic Law 819 of 2003, which requires Congress to conduct the study of the fiscal impact of public spending initiatives, it was unknown in his opinion some draft articles that include words such as "... the authorization of all procedures, comprehensive and immediate ... (paragraph article 3); "... All items and services required ...", "... can repeat against Fosyga, the value of services that are not included in their respective benefit plans ..."; "... The beneficiaries are entitled ... to have the services Household Paso, payment of the cost of travel psychosocial and educational support, according to the needs, certified by the Social Worker ..." (article 4) allow deduce that technology for the treatment of disease and conditions of different quality to that currently can finance the General Social Security System is involved.
Argues that the 3rd, 4th and 13 articles of the bill have access to services and benefits solely on the basis of the existence of the disease, without regard to considerations of efficiency and rationality in the allocation of resources, against which the Court has recommended special care, as the resources of the General System of Social Security in Health and the General System of Units should cover benefits not included in the benefit plans, to the extent that are not available with capacity payment.
For these reasons, the Government finds that the bill produces fiscal impact, since both the contributory system and the subsidized financial system needs increase with the expansion of benefits granted, since they need more resources to fund services in an unspecified amount, generating unquantifiable contingencies in the contributory regime, and additional substantial tax expenses in the subsidized system without cutting to the Executive the project provides or set the source of additional funding to assume those higher expenses.
Argues that as the Act 819 of 2003 a standard of organic nature, ignorance leads to the unconstitutionality of the project as opposed to Article 151 of the Constitution, which states that the rules of that category influence the legislative activity in the matter that they regulate and concludes that the challenged initiative is not consistent with the Fiscal Framework Medium-term, because it is not properly funded with available resources, promoting the imbalance in the General System of Social Security in Health, taking into consideration that it does not It has source of funding to meet the benefits granted therein.
Insists that the review of the contents of POS, both the Ministry of Social Protection as CNSSS, or CRES must analyze various aspects, such as technology available in the country and the epidemiological profile of the population inter alia, for the purpose of that analysis and technical-scientific allowing select services, actions, activities, medicines, supplies, covering better the health needs of the Colombian population and present more effectively, making studies are ahead they must also consult the financial balance of the system, according to projections sustainability of medium and long term.
Ensures
to perform the task given by this Court in what the redesign of the contents of POS refers, is neither desirable nor feasible that the legislator establish and / or include procedures, activities, interventions and medications that increase plans benefits, nor do so without delimitation any or considering the needs of the population and the availability of resources of the General system of Social Security in Health, it not only threatens the financial stability of the system also but also care health for the rest of the population has needs other than cancer, which ultimately ends up affecting the general interest.
Warns that the resources to fund both the Contributory Scheme and the Subsidized remain the same, that is, contributions in the contributory scheme (11 percentage points of the current 12.5) and resources of solidarity (1.5 points from the price of tax) regime and fiscal resources in the subsidized regime and recalled that Law 715 of 2001, assigned to the Municipalities, Districts and Departments, management and financing of health services for the poor not covered with demand subsidies, for which, while universal coverage is achieved, should be aware that although they have resources of the General System of Units and Fosyga, as appropriate, in any case its resources are limited and therefore would not be able to provide comprehensive care, because doing so would affect the territorial finances.
Concludes that extending the Compulsory Health Plan, POS, in both regimes, as a result of the adoption of the draft law objected, did not take into consideration criteria such as the existence of resources to finance, cost-effectiveness, the attention of the most significant risks of the average population and quality and technology available in the country, among others, affects the balance of the General System of Social Security in Health, which is poor for Contributory Scheme, as resources that raises Subaccount Compensation barely cover the current annual expenditure shown in the UPC to be recognized by each member and also spending representing recoveries on account of guardianships and Technical Committees Scientists, that compromise significantly the availability of resources Fosyga.
Finally, with regard to the 5th article of the draft mandating restructuring Care Units for the Care of Childhood Cancer, it estimated that the measure disregards the right to free enterprise of the IPS private, by providing that necessary and necessarily, all of III or IV level should proceed to form such units, unaware that by their specialty may be not interested in its implementation and instead can concentrate their efforts in addressing other diseases; such a decision also adopted without further analysis, in his attentive opinion against the constitutional principle of efficiency in the delivery of health services.
IV. EMPHASIS OF THE CONGRESS OF THE REPUBLIC
cameras stressed the sanction of the bill under review, according to the text approved by them, initially calling attention to the fact that the presidential objections are also signed by the Minister of Finance and Public credit, in its discretion body is not competent to rule on matters other than their portfolio, a situation that in his opinion "clearly confirms the funder criteria by which severe health problems in the country is analyzed".
Reject the objection alleged violation of Article 152 of the Constitution, considering that in Judgment C-581 of 2008, with a presentation by Dr. Manuel José Cepeda Espinosa, left the Court established that a social security policy should not be necessarily subject to statutory law; the argument outlined by the Government also invalid, because it ignores doctrine and jurisprudence that the legislative process of statutory law is not necessary in those matters where, if it is true touch on issues of fundamental rights, not affecting the core is presented essence of those rights.

They claim that if the object of the project is to decrease the rate of cancer mortality in children and adolescents under 18 years must be concluded that it is not intended in any way affect or modify the core of the fundamental right to health but, on the contrary, it adopts a legal tool that seeks to ensure its effective enjoyment of a group of people which are not being guaranteed them that right, which is why its procedure corresponded to that of an ordinary law .
Indicate that in the preamble is the statistical information showing that countries with similar levels of development to ours have achieved strong results in the treatment of childhood cancer, only through instruments such as those provided for in the bill, where certain mandatory requirements enshrined in the detection, treatment and monitoring of such pathology.
In his opinion the government interprets paragraphs isolated and decontextualized from off the Judgment T-760 of 2008, to oppose the bill, which in his opinion is not consistent with the essence of that statement, that being guardianship has only effects inter parties and considered "funny" that the government invoke judicial decisions condemning the State for its inefficiency, negligence or ineffectiveness. They estimate that judgment is completely in harmony with the objectives of the bill, because there are recognized "broadly, but generally," all the shortcomings in the implementation of the current regulations on social security in health, which are reflected in guardianships users constantly stand in whose favor the provision of comprehensive treatment is ordered.
Not accept the objection that the project prevents or interferes with the adoption of measures to correct regulatory failures, because in his opinion although a comprehensive approach is needed, there are priority diseases such as childhood cancer, whose delay regulation is encouraging that at least two children a day die from mainly administrative errors in the detection and treatment of disease.
For the legislative chambers the bill is not changing plans of social security benefits in health, as they have not done in his opinion the judgments of the Constitutional Court ordering comprehensive care, medication, treatment or procedures excluded from these plans and added that the Technical Committees scientists operating in the EPS, try to compensate for this problem, with severe limitation, in cases of children with cancer, the terms imposed for its decisions and the requirements and procedures later, undermine the effectiveness of treatment.
Claim that there is consensus among physicians advising the development of the bill, that users after filing guardianships, raise petition rights, present interviews with scientist, CTC, etc. Technical Committees, achieve approval treatments and / or prescription drugs, but to the detriment of the opportunity of attention.
Indicate that the bill does not contemplate a basket of infinite services as is "normatizando" timely supply of drugs and / or procedures formulated traffickers, according to medical criteria of rationality and quality, but in specialized centers and expert in the care of this condition in children is presented differently staff.
Justify financing foster home, being shown to be essential for children remain in treatment, especially those living in villages or remote areas of the country, support being provided by NGOs, or the same families making collections to get the necessary money, which does not guarantee adequate care of children, "who are complicated with the greatest economic cost, or die with the immense social cost that the loss of a child brings."
Equate with that service "home care" or "hospice" of terminally ill patients, which is being provided by some EPS, with the difference that for the treatment of children with cancer, increases the service assurance success because it comes centers gifted attention for this purpose, where with comprehensive and timely attention and proper socio-emotional support, can be achieved "rates higher survival to 80% and in many cases complete cure of the disease ".

They point out that in developed countries 33,000 annual cases of childhood cancer occur in developing and 180,000 are presented; in the first 100% of children have access to treatment, while in the latter, only 20% on average; therefore it is not surprising that the rate of complete healing in rich countries reaches 75% and poor countries just 2.5%, on average, projections showing the sad scenario to 2010, when rates of life will , 90% and 20% for developed and developing countries, respectively, a situation that requires public policies that defy this trend, "as several countries similar to ours, they have done".
Legislative chambers For these studies also indicate that despite the structural factors that determine the behavior of the indices in our country, we can improve significantly if care models are adjusted, and the provision, human talent and technology, as happens in the Hospital of Recife, Brazil, where he spent a dropout rate of 16% to a mere 0.5%; and survivals, free event from 32% to 63% in about 12 years, due to the transfer of children to a Maternal and Child Hospital oncologist permanent pediatrician and trained staff, quick access to pediatric intensive care and adequate psychosocial support; also mention the experiences of Guatemala, Nicaragua, and Mexico, countries that improved their models of care and treatment for those diseases, in appropriate centers.
They argue that the initiative would have required the processing of statutory law if regulate the fundamental right to health structural, full and complete, which does not happen, because what the bill seeks is not to change the conditions of delivery nor guarantee that right, but, on the contrary, to extend its effective enjoyment, after analyzing factors of administrative nature that are affecting the high mortality rates presented Colombia in these pathologies, which are virtually curable in many countries world.
They argue that Law 972 of 2005, which adopts rules to improve care of the population suffering from ruinous or catastrophic diseases, especially HIV / AIDS, was processed as ordinary and ask why the Executive does not want to give the same prerogatives thousands of children living in Colombia who die of cancer.
They say that although the Ministry of Social Protection issued Resolution 1043 of 2006, to improve the quality of care of children with cancer, it is insufficient "and does not guarantee comprehensive, relevant and effective services that truly impact in mortality rates, survival and abandonment of patients "because to apply chemotherapy, the only requirement requiring care centers is to have a pharmacy and a pharmacist chemist, but does not set a minimum standard for the number of patients also opening the possibility of hiring onco-hematologists to "availability"; also it requires pediatric oncology units have confused psychosocial support and medical care requirements of children with the elderly, among other serious shortcomings.
Legislative cells do not accept the objection concerning the definition of contents of POS by legislation, since in his opinion it is necessary to make adjustments to the model of care for children with cancer that can not continue to die in inconceivable percentages and They say the initiative is not "parceling" the care of the sick, precisely because it aims to be comprehensive, to improve their effectiveness.
They also reject the objection pertains to the alleged imbalance that would cause the national finance bill in the medium-term framework, since in his opinion from the 1991 Constitution enjoyment of a fundamental right can not be subject to conditions of any kind, much less financial, but does not mean that there should be proper coordination between the budget and planning general social security health.
They argue that while it is true that the Executive is entitled to object to a bill, if their reasons collide with the guarantee of an essential end of the state, or a fundamental right, such attribution must yield "to the urgent work public authorities to ensure the effective enjoyment of such rights under the rule of law ".

Not find any explanation for that "for purely economic reasons", the guarantee of the fundamental right to health of children is hindered; in this regard it considers that the objection should be raised in constitutional terms, as well as how it is sustained unknown freedom of Congress to regulate concerning social security and disability benefits, old age and death, which is limit rights fundamental, but not fiscal or economic aspects.
They refer to the joint responsibility of the various players in the social security system, including the State, in order to ensure proper enjoyment of the fundamental right to health and indicate that childhood cancer treatments in Colombia are guaranteed from the financial point of view, but what is required is to adapt the models of care, improve administrative aspects regarding the opportunity of authorizations, providing quality drugs, standardize protocols and making care Units are adequate.
They say that the bill does not require technology, but standardization, implementation and monitoring of care guides and comprehensive treatment by qualified professionals in the field, provided a timely manner and in specialized sites for this purpose, such as hospitals III or IV level of complexity; in this regard, they said the comprehensive treatment of 1200 children diagnosed annually need to survive cancer, it will not break the Social Security System in Colombia, even as the vast majority of requirements are contained in benefit plans.
They refer to the comments made by the medical community who helped structure the bill, under which much of what is said "invest" in childhood cancer is nothing other than wasting resources on inappropriate treatments, incomplete and with disastrous results, why it was proposed attention to guidelines or protocols, which necessarily involves analyzing factors such as cost-effective and available technology relationship, which would avoid the extra cost of the current poor care.
Explain the project to reorganize what is spent and how it is spent and claim that the only "additional cost" is the foster home, which helps save most 30% of patients discontinuing treatment because who dies does irretrievably; also argues that although the cause of this neglect is multifactorial, it is shown that the highest percentage of people thus acts for reasons attributable to the health system.
Assert that to cover the costs of a foster home or group home, and displacement of children with a family member for treatment of uninterrupted, timely and effective manner in Cancer Units proposed that part of use Solidarity Fund resources and Guarantee Fosyga, whose revenues are not executed in full for each term, according to study by the Ministry of Social Protection.
They note that when analyzing the income and expenses of Fosyga, in the period 2003-2007, the revenues exceed expenses and leave room to finance the minimum logistical requirements needed by children with cancer, to improve the effectiveness of treatment and affect recovery, thus impacting mortality rates for this cause and estimate the need for resources to cover these costs would be approximately $ 2,800 million annually.
Indicate that each year 1,200 children are receiving cancer treatment in Colombia and of this total, approximately 400 would need the support that sets the project in terms Paso and travel home, the rest is located in departmental capitals that would drive cancer, or belong to socioeconomic strata who can afford these costs; They argue that each child would require an average of $ 7,000,000 per year and that the use of this support should be regulated by the Ministry of Social Protection, only to reach the population that requires it.
As to the 5th article of the bill, the legislative chambers believe there is a misunderstanding in interpreting the rule is forcing all the IPS III and IV level of care to enable children's Cancer Unit, preying and against the right to free enterprise, because contrary to what expresses the Minister of Finance, the measure aims to ensure that those IPS that want to offer the onco-hematology pediatric, must be the third or fourth level of complexity, since according to studies, 40% of children need intensive care unit.

They say that at the discretion of specialists, clinics currently proliferating type "garage" services that offer pediatric onco-hematology, but provide no guarantee of appropriate care to children with cancer, serious attempt on his life; however, accept that could be written differently the disputed article to make clear that the requirement to conform Cancer Units in hospitals III and IV level of complexity does not imply an obligation for these institutions offer this service if they are not interested .
V. STATEMENT BY THE COLOMBIAN ASSOCIATION OF INTEGRAL MEDICINE, ACEMI
Acemi Executive Chairman, intervened in the process of reference to challenge the bill contested by the Government, considering that affects the financial balance of the General System Health and Social security, to extend the Compulsory Health Plan, POS, the contributory and subsidized regimes, "by including the comprehensive and unlimited treatment for cancer, without considering the limited resources that fund the criteria of cost-effectiveness for the inclusion of health care services in the POS, the most significant risks to the population or the average quality and technology available in the country. "
Argues that the provision of all services required, involves the introduction of technology, which most affects the sustainability of the disputed initiative adding that by establishing inclusions in the POS by way of law, agency to update (National Council of Social Security in Health, CNSSS, while entering into operation Regulatory Commission on Health, CRES), become unable to reduce them, when this is required according to the epidemiological profile of the Colombian population, and according to the criteria of cost-effectiveness to be taken into account for the development of any system of social security.
It claims that users of the General System of Social Security in Health, SGSSS, who suffer from high-cost diseases other than cancer, get attention lower contents prestacionales given to patients with cancer, and there are technical reasons that indicate you to body responsible for updating the POS, which should prioritize the attention of other diseases other than the disease.
He notes that in Judgment T-760 of 2008, this Court addressed the structural flaws of the General Social Security System in Health and demonstrate the lack of clarity in the definition of the contents of the POS, as well as deficiencies in updating, he ordered the National Council of Social Security in Health, update and unify the benefit plans, by establishing the methodology that incorporates, among other things, the financial balance.
Considers that through the bill defines the reference Congress of the POS, including comprehensive cancer care and unlimited for those under 18, regardless of the methodology outlined by the Constitutional Court, "all time which was not attended by the medical community and users suffering from different diseases to cancer, and no analysis was performed with respect to the financial sustainability of the General Social Security System in Health ".
Notes that the project violates the principle of efficiency enshrined in Articles 48 and 49 above, as it affects the financial balance of the General System of Social Security in Health, to extend the Compulsory Health Plan, POS of the contributive and subsidized by the inclusion of comprehensive and unlimited treatment for childhood cancer in Colombia, considering further drawback to legislate for a single pathology, "as the definition of cancer as a public health priority, it must be based on the prelaciones fixed in compared to other diseases requiring investment of resources. "
In this respect, esteem important to note that in addition to establishing an unlimited content services, the draft law does not state objected additional source of funds to pay benefits imposed and does not define the resources financed ambulance services, comprehensive rehabilitation with comprehensive and multidisciplinary approach to support palliative care from the start of treatment and achieve the best quality of life of patients and their families, which should be different from those borne by the General System of Social Security in Health.

It ensures that the National Council of Social Security in Health, and in the near future the Health Regulation Commission are the competent authorities to define and quantify Benefit Plans Unit Capitation Payment, UPC, as well as reduce or exclude some of the features of the POS, having as limiting the inclusions contained in the disputed project, precisely because they come directly from the law, a situation which in the opinion of the intervening, "inflexibiliza the definition of the contents of the Compulsory Health Plan - POS , which must be updated annually. "
He asserts that the draft law also violates challenged the principle of universality enshrined in Articles 48 and 49 of the Charter, to affect the resources that finance the General Social Security System in Health, restricting the expansion of coverage Subsidized regime, because pressing the increased cost of POS, the money available would not allow extended to persons not covered and prevent improve the benefit plan in both regimes.
States that the bill also violates Article 333 of the Constitution, which enshrines freedom of enterprise, by forcing service providers have health Care Units Childhood Cancer, without regard to specialty services that they have arranged to offer in the market.
It states that according to the case law (Judgment C-616 of 2001), when the legislature allows individuals to participate in the provision of health services must guarantee the very conditions of free enterprise, providing conditions and commercial advantages they deem appropriate that constitute the core of free competition.
In this regard, said the bill reference, affects the core of free enterprise, insofar as it requires providers to have infrastructure to provide services that do not consider appropriate, "well for non-economic, or simply because they do not want to offer them in the market for health services "capacity, resulting in its most severe in cases which do not want to provide cancer services seem.
Also argues that the limitation is not due to adequate and sufficient reasons for it, because the obligation to have such Units bears no causal link with the achievement of the intended purpose, because the providers are required to expand their infrastructure, but not the resources are set so that the benefits provided by law come true, "therefore, significant economic damage will be generated to providers, who will not have the expected return."
In his opinion the measure does not meet the criterion of proportionality, because the benefit does not outweigh the sacrifices that entails the measure implies an underfunding since the General System of Social Security in Health will be reflected in the income to be provided by providers to comply with the requirements enshrined in the bill infrastructure.
Notes that the bill also violates Article 151 of the Constitution, insofar as it is not subject to the provisions of Article 7 of Law 819 of 2003, under which the tax impact of any initiative must be explicit and must be included both in the preamble and in the papers, their tax costs and generated additional revenue source for financing.
It argues that the bill violates the above Article 13, which enshrines the right to equality, "to the extent that disproportionately favor smaller cancer patients against other users who have high-cost diseases affect the Colombian population "; It not included within the scope of projection, comprehensive care of high-cost diseases other than cancer, and there are no reasons for not giving the same legislative treatment to sufferers.
In his view, there is another alternative legal measures better protects the right degree and favors the realization of the purpose of the provision with the same intensity, since Law 100 of 1993, as amended by the 1122 Act 2007 empowers the CNSSS, while entering into operation CRES to define and update the prestacional content POS, according to the health needs of the citizens and the financial balance of the system, must bear in mind that "the unlimited coverage not exist in any country the world, in view of the economic resources that finance such services are scarce. "

Expresses that while it is laudable the purpose of the project, seek unlimited care of ill cancer unbalancing the Social Security System in Health does not outweigh the sacrifices that are imposed other users, who will see reduced benefits plan , which "is detrimental to them cancer patients, to the extent that the imbalance that leads the measure would mean the medium term, failure and total breakdown of social security model established by the Constitution".
VI. CONCEPT OF THE ATTORNEY GENERAL OF THE NATION
Mr. Attorney General's Office requests the Court to declare unfounded the presidential objections to the bill, by holding, first, that Congress did not infringe Article 152 of the Constitution when they discussed and passed as an ordinary law, since in his opinion the initiative "does not regulate comprehensively the right to health, and therefore does not affect its essential core ... not infer from it a structural change in the service or the children ": existing, limited to treatment of a particular disease, cancer, and for a specific population of special constitutional protection in accordance with the provisions of Article 44 above plans. Is
away from the considerations set out by the Government to refrain from punishing the bill under study, considering that aims to meet the child population, special protection subject suffering from a disease classified as catastrophic and high cost, offering a comprehensive and timely care with a view to providing better guarantees for the preservation of the right to life of children.
Argues that according to the statistics presented in the preamble, childhood cancer affects about 1,200 children each year, making the disease one of the leading causes of death in this population, "but in turn, is one of the which offers better recovery before early detection, early diagnosis and proper treatment, so that comprehensive and timely care in the treatment of cancer offers prospects for improvement for the patient. "
Argues that the project far from ignoring the Constitution and jurisprudence, fulfills rogatory since this corporation have addressed the Government and the legislature on the issue of health in Colombia, to meet international standards, especially , General Comment 14 of the Committee on Economic, Social and Cultural Rights. Attorney
For the disputed project also gives effect to the constitutional principles of efficiency, effectiveness, universality, continuity and legitimate expectations, since not distinguish between children who have the disease, "surrounding the law of full universality which guarantees equality of patients. "
Considers that subject the sick child and his family to the realization of "red tape, legal struggles and additional economic scuffs" affects the quality of life of patients and their environment, "breaking out again the already difficult situation it means addressing a disease of the features that has cancer, then such wear, in most times get an order of comprehensive treatment of a judicial nature, which sometimes arrive late. "
Initiative states that the orders, clarifies and facilitates access to health care for the child population suffering the painful disease, serving citizens and legal claims requesting the legislature to address these problems with answers that really consult the social reality of the country and also fulfills the commitment to comprehensive health care, in the form as understood by the Constitutional Court.
Attorney notes that the legislature has wide freedom of legislative configuration, which allows you to pass legislation on health issues and as to the exclusive jurisdiction to regulate the fundamental right to health head of administrative bodies, believes that if its function is important to provide cohesion to health care, providing guidelines for the expansion plans and the inclusion of drugs in each of the regimes, this does not prevent Congress "propose, discuss, review and approve the laws it deems appropriate to address the treatment of certain diseases as in this case is of paramount importance, "why requests declared unfounded the objection.

Finally, states that in the preamble to work information showing that more than increase state expenditures, the bill aims to sort, because currently the care of children suffering from catastrophic illnesses, such as cancer, provided in compliance with rulings protection under the Solidarity Fund and Guarantee Fosyga, and in that sense, in the discretion of the Attorney the project does not represent fiscal imbalance, because the resources of the fund meet the fiscal requirements that require the application of law, so that there is no lack of article 7 of law 819 of 2003 on fiscal impact analysis.
VII. CONSIDERATIONS OF THE CONSTITUTIONAL COURT
First. Competition
The Constitutional Court has jurisdiction to decide definitively on the objections raised by the national government, as provided by Articles 167 and 241-8 of the Constitution.
Second.
legal problems for the Court to determine whether, as noted by the national government, objected to the draft law is unconstitutional because it was handled as an ordinary law when its content, pertaining to the guarantee of the right to life of children with cancer, you should have received the process of statutory law, in accordance with articles 152 and 153 higher.
Should also establish whether the challenged initiative infringes the general and universal nature of the right to social security (Article 48 Const.), Establishing overcome constraints that prevent failures in the comprehensive and coordinated regulation of Social Security System in Health revealed by this corporation in the Judgment T-760 of 2008, to the detriment of the rights to health and life of children.
It also must examine whether the processing of the draft Congress ignored the mandate of the 7th article of the Law 819 of 2003, which commits him to the analysis of fiscal impact of public spending initiatives, in line with the Framework Medium Term Fiscal.
Finally, you must determine if the article 5 of the project, recognize the right to free enterprise of the health institutions -IPS- private character by forcing them to implement Care Units Childhood Cancer, UACAI.
Tercera. Pending verification of the objections to the bill under review
Before addressing the study background of the presidential objections, the Court must verify whether the process meets the constitutional budgets, for which recall that according to the jurisprudence [1 ] the competence to decide on the constitutionality of challenged projects by the national government, is not only substantial but also procedural, as includes verification procedure given on constitutional and legal norms that regulate [2].
In this case, the procedures assortments after the approval by Congress of the bill reference, are summarized below:
1. Official letter of November 12, 2008, received the 20th of the same month and year (f. 47 cd. Principal) in the mailroom of the Office of the President, the Secretary General of the Senate referred the bill to the President of the Republic, to executive sanction.
2. In writing the November 27, 2008, he received the next day at the General Secretariat of the Senate, through memorial that also subscribes to the Minister of Finance, President of the Republic returned to Congress, without executive sanction the draft law, the object in all its articles unconstitutional (fs. 24-46 ibid.).
In this regard it should be noted that in accordance with Article 166 of the Constitution, developed by Article 198 of Law 5 of 1992, "the government has a term of six days to return with any project when no objections consists of more than twenty articles; ten days, when the project contains twenty-one to fifty articles; and up to twenty days when items are more than fifty ".
The constitutional jurisprudence has indicated that the days referred to by such provisions are working and not calendar [3]; being so, this Court notes that the draft law under review consists of less than twenty articles, the term to raise objections expired on 28 November 2008, which was met by the Government, as they were presented that day .

3. On December 16, 2008, the Senate, in plenary session, approved the report submitted by the members of the Accidental Commission (f. 27 cd. Ppal.), Where he recommended to declare the objections raised by the Government unfounded. In the same vein the House of Representatives decided in plenary on 24 March 2009 (f. 2 ibid., Where he scored wrongly "2008").
4. Prior to the vote on the report which declared unfounded the presidential objections, was made by the Senate on December 15, 2008, as certified by the Secretary General of that corporation ad (f. 27 ibid.). In the House of Representatives it was held on March 18, 2009, according 162nd Plenary Act that date.
To examine the validity of those ads, the Court must consider its case law [4] on the requirement that Article 8 of Legislative Act 01 of 2003 [5] refers, must meet the following announcement requirements [6]
- must give the president of the chamber or commission, directly or on its instructions, in a different and prior to that in which the vote on the draft should be done session.
- The date of the vote must be true, ie, determined or at least determinable.
- A bill can not be voted at a meeting other than that for which it has been announced, except that this is not made or not that purpose.
- There is no textual sacramental formula or phrase to be used in Congress to make the announcement.
- The use of the term "advertisement" to refer to notices of projects to be "considered" or "debated" in other sessions, must be understood as revealing intend to vote such projects and, therefore, to meet the requirement of Article 160 of the Constitution.
- The context of the discussions and debates can be used as a reference validation to determine if an ad was actually, if included in order to discuss and vote on the project announced and finally, if the session for which announced the vote is a determinable date.
- The context which can be drawn validation criteria is not limited to the session at which the announcement was made, but may include other sessions, including those in which the vote took place.
4.1. About filling announcement at the Plenary of the House of Representatives, the Court observes that occurred in the following terms, as recorded in the minutes of Plenary "162 of the regular meeting on Wednesday, March 18, 2009" (Congress Gazette number 245 of April 24, 2009, pages 29 et seq, cd evidence Chamber):...
"Session Address by the Chair, Dr. Fabio Raul Amín Salame:
Mr. Secretary, announce projects for the next session.
Secretary General, Dr. Jesus Alfonso Rodriguez C .:
projects for the next session in which bills or legislative act are discussed.
Secretary General, Dr. Flor Marina Daza Ramirez:
... ... ... Report on Objections

... ... ... Bill 336 of 2008 House, Senate 094 2007, for the right to life (sic) children with cancer in Colombia.
... ... ... Secretary General, Dr. Jesus Alfonso Rodriguez C .:
... or legislative act. Mr President, the Secretariat informs you that are advertised projects.
Session Address by the Chair, Dr. Fabio Raul Amín Salame:
Mr. Secretary, please certify the quorum.
Secretary General, Dr. Jesus Alfonso Rodriguez C .:
The Secretariat reported that the vote cast, which has disintegrated the decision-making quorum. There is no decision-making quorum.
Session Address by the Chair, Dr. Fabio Raul Amín Salame:
Close the record, Mr. Secretary.
Secretary General, Dr. Alfonso Rodriguez C .:
closes, Mr. President. We deliberative quorum, Mr. President if you authorize can do ... ... ... ... Plenary Session at 7:15 pm arose, and was called for Tuesday, March 24, 2009 at 3:00 pm "(verbatim transcript ).
The above, the announcement of the bill by the legislative body fulfilled the conditions laid down by the law, as was arranged and performed in different and pre-voting session, held on 24 March 2009, some date on which it was voted and approved the report on the presidential objections, as recorded in Minutes of Plenary "163 of the Ordinary Session on Tuesday 24 March, 2009", as follows (verbatim transcript, Gazette 265th Congress April 29, 2009, pages 32 et seq, cd test chamber)...:

"Address of the President, Dr. Miguel Amín Escaf:
Next report on objection, Mr. Secretary.
Secretary General, Dr. Jesus C. Alfonso Rodriguez, reports:
Doctor Hernán Andrade President of the Senate, Dr. Germán Male Cotrino, report objections to the bill for the right to life of children with cancer in Colombia , published in the Congress Gazette 942 of 2008, announced in March 2009. 18
We would then discuss the objections of unconstitutionality and convenience proffered by the National Government through the Ministry of Finance and Public Credit, to justify no sanction by the President of the Republic the bill for the right to life of children with cancer in Colombia, because of the importance of this project we present our responses within the legal point of view, medical, scientific and human.
For the above do not accept the objections raised by the national government through the Ministry of Finance and Public Credit, on Bill 336 2008, 094 2007 Senate for the right to life of children with cancer in Colombia.
Firman Nestor Ivan Moreno, Jorge Morales Gil.
It has been read the report of objections.
Address of the President, Dr. Miguel Amín Escaf:
Considering the proposition with which ends the report on objections that has just been read, discussion, announced that it will be closed the discussion, opens closes the discussion, ask the plenary of the Corporation do you approve the proposal with which ends the report on objections?
Secretary General, Dr. Jesus C. Alfonso Rodriguez reports: President Approved
".
4.2. The announcement in the Senate, recorded in Minutes of Plenary "36 of the regular meeting of Monday, December 15, 2008" and (Gazette number 223 Congress April 21, 2009, pp. 116 et seq., cd tests Senate).
"for Secretariat projects to be discussed and adopted at the next session are announced.
Mr President, the following are the projects to discuss and vote at the next plenary session:
... ... ... With objections
report Bill number 2007 94 Senate and 336 House 2008: the right to life of Children with Cancer.
... ... ... 9:40 pm As the President adjourns and calls for Tuesday December 16, 2008, at 10:00 am "(it is bold in the original text).
Also in the Senate, the announcement of the bill to that proposed for vote and adoption of the report that declared the presidential objections unfounded, as stated in the Act "37 of the regular meeting of the day was held in pre and different session Tuesday 16 December 2008 ", namely (Gazette number 224 Congress April 21, 2009, pages 47 et seq, cd tests Senate...)

IV Objections of the President of the Republic, projects approved by Congress.
Bill number 2007 094 Senate and 336 House 2008, for the right to life of children with cancer in Colombia.
... ... ... The Chair opened the discussion of the report which declared unfounded the objections raised by the Executive and closed the discussion, this imparts its unanimous approval.
... ... ... For all the above, we do not accept the objections raised by the national government, through the Ministry of Finance and Public Credit, on the Draft Law No. 336 of 2008 House, Senate 094 2007, by the right to life of children with cancer in Colombia ". (It is bold in the original text).
5. Finally, through official letter received by the General Secretariat of the Constitutional Court on April 3, 2009, the President of the Senate, pursuant to the order of Sala Plena A-084 this year, he referred the bill to that at the insistence of Congress, the Court will proceed to a final decision on the constitutionality of the contested provision, in accordance with articles 167 and 241, paragraph 8, of the Constitution and 32 of Decree 2067 of 1991.
6. It made the previous tour, it is observed that the process being analyzed, served in Congress and the National Government on the presidential and congressional insistence objections, adjusted the procedure laid down in the Constitution and the law; so, there is no doubt about the due performance of the formality of the objections, the Court will examine substantive objections to the bill reference.
Fourth. Material analysis presidential 4.1
objections. The alleged ignorance of the process of statutory law

For the Executive the bill under review is contrary to the Constitution, because it was passed as an ordinary law, the process must having been given a statutory law, since it develops the right to health of minors with cancer, which express mandate of Article 152 above and the jurisprudence of this Court, it is fundamental, and therefore its regulation must be submitted to the appropriate legislative procedure of such laws.
Cameras insist on the adoption of the bill, arguing that it is not necessary to impart the process of statutory law to proposals which matter, although related to fundamental rights, does not affect the core of the same, which in his view was what happened in this case, since the object of the disputed initiative is not intended to restrict the provision of health services to minors but, on the contrary it seeks to expand its coverage decreasing the mortality rate from cancer in children and adolescents.
Before examining the objection, the Court should be noted that as the government approach is generic and covers the entire project, the statement will perform the same character, as shall be limited to that alleged procedural defect; Furthermore, in such event, "the effects of res judicata must be understood related only to the reasons given by the Government to object, with the constitutional principles on which it has made confrontation and the aspects that have been the subject of explicit analysis by the Court "[7].
According to case law [8], to know whether a certain case requires to be subjected to the processing of statutory law must be addressed, preferably, "the materials on purely formal criteria or nominal"; and therefore, "if a rule does not regulate fully right but it does affect its essential core, must be of statutory law"; and in relation to the matters referred to in Article 152 superior, who must undergo mandatory the processing of statutory law set forth in Article 153 ibid, this Court has stated that there should be a restrictive interpretation, "to avoid removing the general power granted by the same Letter to the ordinary legislator in Article 150 superior "[9], a task that is essential to apply the following traditional criteria for determining whether a rule is subject subject to statutory law [10]:
(i) When the case concerns a fundamental constitutional right and not on a right of a different nature;
(Ii) When using the standard regulates and complements a fundamental right;
(Iii) Where no such regulation touches the minimum conceptual and structural elements of fundamental rights, and
(iv) When the regulation has a claim to comprehensively regulate the fundamental right.
Also noted this corporation to establish whether a certain case should have been handled through statutory law, not sufficient to determine whether the object has any connection with a fundamental right, "as it will be necessary to also determine whether the content regulatory expressed by law from the material point of view, regulates elements found near and around the essential content of a fundamental right, and if engaged restrictions, limits or conditions on these must be checked if they have a proportional basis and constitutionally reasonable "[11].
According to the jurisprudence of this Court [12] in the case of fundamental rights and duties (lit. to Article 152 Const.), The criteria for whether a particular provision that regulates should be dealt with as statutory law are: (i) matter effectively be on rights and duties of a fundamental nature; (Ii) to develop own structural elements and basic principles of right or duty in question; (Iii) which relates to come to the core content of the right; (Iv) regulating aspects inherent in the exercise of the right; (V) that establishes limits, restrictions, exceptions and prohibitions affecting the essential core; (Vi) in the case of a regulatory body that seeks to regulate this holistically, structural and completes a fundamental right that refers to the overall structure and regulatory principles, but not the comprehensive and detailed development; and (vii) that the provision refers to main and important aspects of such rights.

Furthermore, the Court has stated repeatedly [13] that rules on social security "should not necessarily be part of a statutory law" criterion was expressed from the Judgment C-408 of 1994 (September 15 ), MP Fabio Moron Diaz, who, among other determinations, declared constitutional Act 100 of 1993, which established the System of Comprehensive Social Security, considering it unnecessary that Congress imparted the process of statutory law, because its content does not correspond the elements of fundamental rights that the Constitution wished to submit to the legal category, among others, based on the following considerations:
"the Charter provides the power of the legislature to regulate the content of social security, defined as, a time, a 'mandatory public service' and 'an inalienable right'. Technically this contradiction is irreconcilable. However, the consistent interpretation of different competing elements in certain constitutional realities, suggests that social security is a right of the person who materializes through the provision of a public service mandatory.
... ... ... It is clear to the Court that the regulations on social security, should not be regulated by exceptive legal means of statutory law does not correspond to the elements of fundamental rights that the Constitution wished to subject that legal category, because it elements of welfare type coming into opportunities, the existence of an employment relationship, and in others, the mere participation in the social body, and free rights in opportunities and costly in most cases . Gratuitousness can not be understood in the holders of those rights, as an ingredient that could mutate nature thereof to transform them into fundamental rights; because they are nothing more than developments of proprietary content of the rule of law. "
Based on the above criteria, the presidential objection will be analyzed considering the bill under review is entitled "the right to life of children with cancer in Colombia", suggesting that the matters governed correspond the statutory procedure (lit. to Article 152 Const.), since it refers to the right to life, which is indisputably a fundamental right (articles 11, 44 ibid); however, leaving aside the nominative criteria and applying instead the material reaches a different conclusion.
Indeed, in accordance with article 1 of the project under review, its purpose is to "significantly reduce the rate of cancer mortality in children and people under 18, through the guarantee by actors of the social security health of all services required for early detection and comprehensive treatment, application protocols and guidelines of standardized care and infrastructure, staffing, human resources and technology required in specialized centers enabled this purpose ".
In this regard, the bill aims to ensure the right to social security health specifically for persons under 18 years of age with cancer (Article 2), through the following mechanisms:
( i) Ensuring care through the implementation of a database to streamline service provision (article 3).
(Ii) Adoption of a comprehensive model of care, which involves the obligation for insurers to authorize all services required by the child, immediately, from the confirmation of the diagnosis (article 4).
(Iii) Creation Care Units Childhood Cancer, UACAI (Articles 5 ° to 11).
(Iv) Creation of the National Childhood Cancer Registry and the National Single Number for the purpose of carrying real-time recording on the diagnosis, monitoring and treatment progress (Articles 12, 13).
(V) Creation of Social Support Service, which involves having the services of a foster home, including travel expenses, psychosocial support and school (Article 13).
(Vi) Creation of the National Advisory Council of Childhood Cancer and the Departmental Advisory Councils, responsible for carrying out monitoring and monitoring the implementation of the law (Articles 14 and 15).

As can be seen, the subject of the bill under review, although obviously related to fundamental rights such as life and health, is not intended to regulate in a comprehensive, structural and comprehensive, does not develop its basic elements, nor refers to those closest to its essential core content, it seeks to ensure that the beneficiaries of the law -the people under 18, who are in the circumstances described in Article 2O, enjoy the social security service health adequate and timely manner by the relevant institutions, through recognition of welfare benefits and the implementation of administrative mechanisms and outlined operational.
The proposal also establishes limitations that affect the core of the aforementioned fundamental rights, which if established would have affected the constitutionality of the project under review, since as explained, seeks to advance the comprehensive care of that painful illness respect of children under 18 years considered subjects of special protection, in order to significantly reduce the death rate from cancer in those people, through the guarantee by the actors social health of all procedures and services required for early detection and comprehensive treatment, in specialized locations with infrastructure and technology.
Thus, article 3 of the initiative provides that such procedures will be understood as all items and services required for the care of beneficiaries and consultations, support diagnostic tests, medications, surgery and follow-up the patient, which they will have an equivalent management services included in the Mandatory Health Plan, POS, by the insurer or local authority; for its part, article 4 ib. provides that these services be ordered immediately and will be provided in Unit Care of Childhood Cancer, UACAI, according to the judgment of the treating physicians in different specialties and other criteria mentioned therein, with the caveat that if the unit fails that service or has no available capacity, should return it to center this point, without being limiting, paying copayments or prorated fees or waiting periods, regardless of the number of listed weeks; Finally, in accordance with the provisions of paragraph 1o of that article, the UACAI must supply drugs of good quality and ensure the implementation of preventive treatments such as annual influenza vaccination according to guidelines of care and protocols, to avoid the lack of such a move would endanger the effectiveness of treatment of the child.
In sum, as the regulation under consideration it does not correspond to the elements that the Charter required to submit to the procedure of statutory law, as it relates to factors of administrative, operational and welfare nature, related to the State's obligation to ensure efficient delivery of public social security (article 365 Const.), and does not restrict it expands and makes the guarantee of the fundamental right to health of children with cancer, it is concluded that did not require legislative action statutory, why not successful presidential objection.
4.2. The alleged "dismantling" Social Security System in Health
holds the Executive it objected that the draft law is unconstitutional because it establishes restrictions that prevent the state overcome the problems of regulating the Social Security System in Health, analyzed by this Court Judgment T-760 of 2008, affecting, bead, rights to health and life and the rights of children, faults, in his opinion, must be overcome harmony between different instances and not only through legislative measures such as those contained in the bill objected in its feel.
Argues that the initiative also prevents there is a coherent public health policy, it defines the contents of plan benefits, determining matter for the National Council of Social Security in Health, CNSSS, after analysis of their relevance and evaluation of a sustainable financing scheme in time to allow effective access to the benefits provided.

The legislative chambers insist on the initiative, considering that the delay in regulating comprehensively care of childhood cancer mortality encouraged basically by administrative errors in the detection and treatment of the disease; in your opinion, does it change the POS or contemplates a basket of infinite services as it attempts timely supply of drugs and / or procedures formulated by physicians for the treatment of childhood cancer, according to criteria of rationality and quality, in specialized centers and expert personnel matter which in his opinion, can be defined by the legislator, who, for that matter, considered necessary to make adjustments to the model of care in order to prevent children continue to die because of this disease.
Objection to this Court is not bound to succeed, for the following reasons:
Although the reproach of the Executive appear pose a problem to be solved susceptible seat of abstract constitutional review, really outlines a challenge to policy public related to the design and operation of the Social Security system in Health, particularly to scheme attention of childhood cancer by the operators of the system, an issue on which it can not rule this corporation, for the express mandate of Article 167 superior competence rests solely on objections on constitutional grounds, since they do not have that character only conducive to the reconsideration of the matter by the plenary of legislative cells, forcing, before the congressional insistence, to presidential approval of the project without a raise new objections. This is established above the preceptuar said that "President sanction without objecting to the project, I reconsidered, is approved by half plus one of the members of both chambers norm. Excepted the case where the bill is challenged as unconstitutional ".
In addition, when the Constitutional Court, in its role as guardian of the integrity and supremacy of the Charter, comes to decide on the constitutionality of a bill contested by the Government, it can only rule on its formal validity and materials ( Const Article 241-8), for alleged contradiction with the upper system and not for other reasons such as those related to convenience or opportunity of the measures adopted by the legislature. [14]; for that reason, the Court has noted that the consideration by the Court, prima facie, is limited to analysis and decision objections as were made by the Executive [15], and hence can not involve different aspects, which involving the solution of a problem that is not of a constitutional nature.
Different thing is that with the persistent violation of fundamental rights, this corporation, through its Second Chamber Review guardianships, had decided to analyze Judgment T-760 of 2008 (July 31), MP Manuel José Cepeda Espinosa, recurrent problems in providing health service, ordering the Ministry of Social Protection and the Committee on health Regulation, the adoption of various measures on two fronts: the benefit plans and the flow of resources to finance the service, order to prevent in the future continue to submit this situation.
Such determinations are natural expression of the powers attributed to the Charter judges to hear the writ of protection (Article 86 Const.) And competition that the Constitution gives the Constitutional Court to review judicial decisions amparo (Article 241-9 ib.), in accordance with the procedure provided for in Decree 2591 of 1991, which regulates the exercise of such action.
This control, although it seems unusual, in fact it is not, because unlike the abstract control of constitutionality, is aimed at ensuring the effectiveness of fundamental rights by verifying the rationality of government policy and its consistency in the light of the constitutional duties of the State, in relation to the efficient delivery of health services (articles 49 and 365 Const.), without falling back on the design and content of it or on the mechanisms and programs developed for implementation and performance.

In application of the rule that enables the judge to set the other effects of fault protection to ensure the full enjoyment of the injured party violated right, keeping competition until it is fully restored the violated right (Article 27 of Decree 2591 1991, final paragraph) [16], the Second Review Chamber issued 14 orders, reserving the power to monitor the implementation of agreed measures by requiring periodic reports of progress, prioritization and concrete goals. Precisely one of those orders is related to the unification of the benefit plan established for minors, a matter for which the following was decided:
"Twenty-first. Order the Commission of Health Regulation unify benefit plans for children in the contributory system and the subsidized measure to be adopted before 1 October 2009 and should take into account the necessary adjustments to the UPC subsidized boys and girls to ensure financing for the expansion in coverage. Should that date have not taken the necessary measures for the unification of plan benefits children, it is understood that the Mandatory Health Plan Contributory Scheme covers children of the contributory scheme and the subsidized scheme.
A report on the process of implementation of this order shall be referred to the Constitutional Court before 15 March 2009 and reported to the Colombian Institute of Family Welfare and the Ombudsman.
If the Health Regulation Commission will not be integrated for November 1, 2008, compliance with this order corresponds to the National Council of Social Security in Health ".
As can be seen, the order is not addressed to Congress but an agency of the Executive Branch, which does not mean that one has lost power to regulate matters relating to the health service, as it pertains to adequate, timely and efficient delivery as well as the definition of the corresponding benefits, as seems to suggest the Government's objection.
Certainly repeatedly this corporation has indicated that the application of Articles 48, 49, 150-23 and 365 above the legislature has freedom which is absolutely no way to regulate the provision of services health, since it is limited by respect for the values, principles and rights of higher order [17]; in that sense it has established that Congress has broad margin of discretion to determine, for example, what entities in the public or private sector can provide the health service, the regime to which they are subject, allowances and benefits, and other related aspects at the same [18] as well as define and specify the institutional mechanisms and relevant procedures and may use different mechanisms and designs to develop and realize this right [19].
However, he insisted that such authority has clear constitutional limits on principles, values ​​and rights of higher order, which restrict and define configuration freedom legislator in this matter. Among other parameters the legislature to regulate the right to health must take into account (i) the compulsory and irrevocable character; (Ii) its provision as a public service whose management, organization, control and surveillance is established under State responsibility; (Iii) the principles of universality, solidarity and efficiency [20]; and (iv) respect for the principle of equality [21], which could be violated when the legislature "uses criteria suspects differentiation or potentially discriminatory" [22], involving different treatment to similar situations or similar warranting the same treatment.
In the case under review, this Court finds that the legislature has exercised its power configuration within these limits, and which aims to make the fundamental right to health of minors reality (Article 46 Const.) through the provision of social security in accordance with the principles of universality, solidarity and efficiency, by consecrating the comprehensive care of the child with cancer, regardless of whether they are affiliated or not to the social security system so that you are authorized with all the procedures required in the Child Care Unit Cancer, UACAI, without being limiting copayments or prorated fees or waiting periods, regardless of the number of listed weeks.

Warns this corporation that the initiative away from interfering in compliance with the measures taken in the Judgment T-760 of 2008, is oriented towards the unification of the benefit plans of those under age orderly in that order, since in which the attention of childhood cancer is concerned, enshrines the guarantee of comprehensive care equally for all children with cancer, without regard to the kind of regime they belong or are simply linked to the system Social security in Health.
In that regard, this Court is clear that such a measure does not entail violation of the right to equality, since it is reflection of the mandate enshrined in Article 13 above, under which the State must especially protect those who for their economic, physical or mental condition, are in obviously vulnerable circumstances, indisputably they belong group to which minors suffering from cancer.
Finally, if the sake of argument were to be accepted in case the possibility of a ruling seat of abstract control over aspects of the desirability or effectiveness of the project and its implications in shaping the public policy of the sector health, could not examine the objection, since the government did not present evidence of his claims, merely make general disquisitions on the existence of alleged "restrictions" and "obstacles" in the bill under consideration, which it considers prevent the articulation of the Social Security System in Health.
4.2.1. The C-662 2009 Judgment and the principle of comprehensiveness in the General System of Social Security in Health, SGSSS
This Court, in deciding the presidential objections to the bill number 2008 312 Senate Chamber 90, 2007 "Law Sandra Ceballos, by which the actions for comprehensive cancer care in Colombia are established "made it impossible to issue substantive ruling on the grounds that the government only raised legal qualms about the project against the SGSSS, whose content is optional Congress as its power configuration on the matter, according to the dictates of articles 48 and 49 of the Constitution. On the subject [23], he said:
"3.4.2. In the opinion of the Court, the objection raised by the Executive does not offer the necessary parameters for the Court to issue a ruling on the merits, while not pose a contradiction between the parliamentary initiative and the Constitution, but is restricted to contrast the project of law above rules strictly legal nature. In this regard, the objection raised provides a false problem of constitutionality, based on (i) the lack of control parameter for the case of the presidential objections; and (ii) the wrong of the principle of comprehensiveness, defined by the Judgment T-760 of 2008, understanding from the collection that decision made the constitutional jurisprudence on the implications, from the perspective of the Constitution, public service health care.
3.4.3. As it indicated in the legal basis 3.3. of this judgment, the content of Articles 48 and 49 CP, the Constitution gives Congress the power to define the content of SGSSS, implying that the organ of democratic representation has the ability to set different modes of organization prestacional and institutional health system, subject only to the material and substantial limits discussed above.
For the proposed case, the Executive part of a substantial budget, according to which the fact that the Judgment T-760/08 would have recognized as valid, from the constitutional perspective, institutional arrangements and expertise under the law 100/03 and law from 1122 to 1107, a limitation to the legislature regarding the regulation of different ways of defining the content of SGSSS arises. Thus, the draft law objected, while departs from the initial legislation and, in particular, that this regulation powers conferred on the CRES arrogates, violates the Constitution.
This objection ignores that constitutional rules governing SGSSS state that corresponds to the legislature autonomously, defining the content of SGSSS. This means that Congress, once the reasons for political and social desirability corresponding to parliamentary work analyzed, can make changes to the health system. In that sense, it lacks support the claim that the above legal rules set a limit for such exercise of legislative configuration.

This freedom of legislative configuration, likewise, is not limited by the recognition of the constitutional validity that the Corporation makes a particular model of organization SGSSS. In this regard, it should be noted that the Judgment T-760/08, the Second Review Chamber of the Constitutional Court reviewed various rulings of protection related to failures in medical care lavished by the SGSSS and ordered a series of structural orders to different instances of the system, aimed at correcting the main shortcomings of it, unaware of the duties of protection, respect and guarantee the fundamental right to health.

... ..., The Court established that structural orders adopted would be addressed to the authorities and bodies SGSSS, who had set the law. Consequently, he directed particular the Ministry of Social Protection, the CRES and CNSSS forecasts, while institutions that Congress had assigned competence in defining the specific content of the health system. This decision is part, then, on respect for the democratic principles and constitutional norms that give the legislature, not judges, defining the content of SGSSS.
However, this decision does not mean, in any way, the petrification of the power of the legislature to establish various forms of institutional arrangement SGSSS. Thus, if Congress exercising its constitutional competences and submission of formal limits and referred to above materials, decide to modify this legal system configuration health care, such a forecast, as with the draft challenged law is a constitutionally legitimate expression of the power of standard configuration.
On the other hand, it should be noted that the alleged shortcomings in applying the rules of the bill, because of the conflict of jurisdiction that generates between different institutions SGSSS, especially CRES is a matter which clearly falls within the questions for the convenience of the legislative initiative. These issues, as derived from the provisions of Article 167 CP, beyond the control of constitutionality making the Court in this instance. "
This corporation emphasizes that the reason stated by the National Government, study, keep identity with said in Judgment C-662 of 2009 cited, as both assume (i) the problems of the Colombian population with cancer under a same pattern analysis, (ii) the understanding we have about the principle of integrity, recognized by the Court in the Judgment T-760 of 2008 and (iii) the design and purpose of the General System of Social Security in Health, SGSSS, and the Regulatory Commission of Health, CRES, according to the power granted by the legislature, sufficient for the Court to reiterate indicated in this judgment as a line of interpretation given the approach of the Executive, that because of legal lineage reason, it agrees with the mandate of Article 167 above, according to which competition rests solely on objections on grounds of constitutionality.
For the Court the principle of comprehensiveness is related parameters legal nature as computer criterion the General System of Social Security in Health, SGSSS, so that people ensure the health requiring treatment, especially if it is a catastrophic illness or are engaged life or personal integrity, competence constitutional system legislator whose content and scope are not feasible to be unknown by constitutional objection. In this regard, this corporation in the aforementioned Providencia C-662 of 2009, concluded: "(i) recognition in a judicial decision given institutional design SGSSS, is not incompatible with the possibility that the legislature establish new forms of regulation, competition which it is subject only to the formal and substantial limits described above; (Ii) the principle of comprehensiveness, which is based on rules established by Congress in the exercise of that right of legislative production, not a constitutional duty to restrict the legislative formulas on the content to SGSSS only those stipulating rules derived for the general population subject of health care; and (iii) the objection raised establishes a false problem of constitutionality, however, points to the proper exercise of the powers of appropriation and budget execution, and implementation of public policies, all by the National Government. "

Based on the foregoing, the Court finds that in this case, like as discussed in Judgment C-662 of 2009, it is the absence of sufficient to rule on the matter raised arguments. Therefore, the utter room inhibitory decision as it pertains to the objection based on "dismantling" the General System of Social Security in Health.
4.3. The alleged absence of fiscal impact analysis required by Article 819 of the Law on the 7th 2003
According to the Government, the bill under review presents a procedural defect affecting its constitutionality, considering that Congress approved without previously had performed the analysis of fiscal impact of the initiative, taking the Fiscal medium-term framework, in compliance with Article the 7th of Law 819 of 2003 and the provisions of Article 151 superior, ordering address that requirement; He explains that the obligation on insurers to authorize all services required by the child with cancer, halfway houses and travel expenses, psychosocial support and school, "allow us to deduce that technology for the treatment of disease involves "increasing the financial burden of the system, as a result of the expansion of benefits, both as subsidized contributory scheme.
Congress rejects the accusation made by the Executive, considering that in the light of the Constitution the enjoyment of a fundamental right can not be subject to conditions of financial order, without implying ignore the link between budget and planning the general social security health, adding that the objection, besides not being raised in constitutional terms, ignores freedom of configuration legislator in social security.
To resolve the question of the Government, it should be remembered that in accordance with Article 819 of the Law on the 7th 2003, projects on public spending Congress should incorporate the study of the fiscal cost of the initiative and the source additional revenue generated to finance it. So what sets the standard in question:
"Article 7.. Analysis of the fiscal impact of standards. At all times, the fiscal impact of any bill, ordinance or agreement, to order spending or giving tax benefits must be explicit and must be consistent with the Medium Term Fiscal Framework.
For these purposes, you must explicitly included in the preamble and in the papers respective processing fiscal costs of the initiative and the source of additional revenue generated to finance the cost.
The Ministry of Finance and Public Credit, at any time during the respective procedure in the Congress, must submit their concept against the consistency of the provisions of the preceding paragraph. In any case this concept may go counter to the Medium Term Fiscal Framework. This report will be published in the Gazette of Congress.
The bills of government initiative to raise an additional expense or a reduction of income should contain the corresponding alternative source by decreasing spending or revenue increases, which must be analyzed and approved by the Ministry of Finance and Public credit. In local authorities, the procedure provided for in the preceding paragraph will be stocked to the respective Ministry of Finance or his substitute. "
This Court has analyzed the meaning and scope of the above provision [24] as well as the implications of noncompliance carries on the constitutional validity of public spending initiatives. Judgment C-502 in 2007 (July 4), MP Manuel José Cepeda Espinosa, in which he studied the constitutionality of statutory bill number 207/05 34/05 Senate and House, "for which Article 227 is developed the Constitution, in relation to the direct election of the Andean parliament, "laid the following doctrine, which is transcribed in full:

"The 7th Article of Law 819 of 2003 requires that any bill, ordinance or agreement to order expenses or tax benefits granted explicit what their fiscal impact and compatibility be established with the Medium Term Fiscal Framework dictates annually by the Government. For this purpose it provides that in the preambles of projects and in each of the papers for discussion should explicitly include the fiscal costs of projects and the source of additional income to cover these costs. Similarly, it states that during the processing of projects the Ministry of Finance must pay concept about the fiscal costs have been estimated for each of the projects, as well as the source of income to cover and compatibility project with the Medium Term Fiscal Framework.
Obviously, the rules contained in the 7th article of the Law 819 of 2003 are an important tool for streamlining legislative activity, so that it is done knowingly fiscal costs generated by each of the laws passed by Congress. They also allow law established in harmony with the economic situation and economic policy laid down by the relevant authorities. This certainly contributes to public finances in order, which has a favorable effect on macroeconomic stability.
Similarly, compliance with the requirements set out in that Article the 7th must have a favorable impact on the effective implementation of laws, since the approval thereof will occur only after meeting its expected fiscal impact and the possibilities of financing. This indicates that the approval of laws will not be accompanied by the continuing uncertainty about the ability to perform or in developing public policy embodied in them. With this, the instruments contained in the 7th article analyzed can contribute to overcoming the existing tradition in the country -of such deleterious effects on the Rule of Law- leading to pass laws without being incorporated into the design of the same -administrativos the necessary elements, budgetary and technicians to ensure its effective implementation and to monitor the obstacles to their full, timely and full compliance.
So said the 7th article of the Law 819 of 2003 stands as an important tool both to streamline the legislative process and to promote the implementation and enforcement of laws, as well as the effective implementation of public policies . But this does not mean that it can be interpreted that this article constitutes a barrier for Congress to exercise its legislative function or process load falling upon the legislative exclusively.
35. Indeed, given the current conditions in the Congress works, admit that the article on the 7th of Law 819 of 2003 is a requirement process, which creates an additional burden and exclusive on the Congress in forming projects law, means, in practice, considerably curtailing the power of Congress to legislate and grant the Ministry of Finance a kind of veto power over bills.
On the one hand, the requirements contained in article assume that Congress, or the bancadas- have sufficient knowledge and tools to estimate the fiscal costs of a legal initiative to determine the source which could be financed and to assess their projects against the Medium Term Fiscal Framework. In reality, accept that the conditions set out in Article the 7th of Law 819 of 2003 are a requirement pending incumbent comply solely to Congress disproportionately reduce the power of legislative initiative lies in the Congress of the Republic, which the principle of separation of the branches of government, to the extent that seriously injured Legislative autonomy is violated.

Indeed, the almost insurmountable obstacles that would arise for the legislative activity of the Congress would lead to grant a form of veto power of the Minister of Finance on the bills in Parliament. The Ministry of Finance is who has the necessary information to enable estimates of the fiscal costs to establish where the resources can arise to assume the costs of a project and to determine the compatibility of projects with the Fiscal Framework Medium Term. He would have to go congressmen or thwarts who want to present a bill involving expenditure. Thus, the Ministry would decide which attends requests and the priority to do so. This would acquire the power to determine the legislative agenda at the expense of the autonomy of Congress.
But also, the Ministry may decide not to intervene in the process of a bill that would generate fiscal impact or simply ignore the processing of projects. This could lead to the project was approved without the position of the Ministry have been heard and no accurate way to know whether the project conforms to the macroeconomic requirements set out in the Medium Term Fiscal Framework. In fact, this situation already presented in the case analyzed in Judgment C-874 of 2005 -Back reseñada- and the President of the Republic objected to the project because the Ministry of Finance had not conceptualized about the legal initiative. However, as she reminded, on that occasion the Court stated that the failure of the Ministry of Finance did not affect the validity of the legislative process.
36. Based on the foregoing, the Court considers that the first three paragraphs of article on the 7th of Law 819 of 2003 should be understood as parameters of rationality of legislative activity, and as a burden that initially rests with the Ministry of Finance, once the Congress has reviewed, with information and tools at its disposal, the tax implications of a particular bill. This means that they are tools for improving legislative work.
That is, that article must be interpreted as meaning that its purpose is to obtain that laws be enacted taking into account the macroeconomic realities, but without creating insurmountable barriers to the exercise of the legislative function or create a power of legislative veto head of the Finance Minister. And in that process of legislative rationality the main burden rests with the Ministry of Finance, which is the one that has the data, teams of staff and expertise in economic matters. Therefore, in the event that the Congress dealing with a project incorporating erroneous estimates of the fiscal impact, on how to address these new expenditures or the compatibility of the project with the Attorney medium-term framework, it is up to the Minister of Finance intervene in the legislative process to illustrate to Congress on the economic consequences of the project. And Congress is to receive and evaluate the opinion issued by the Ministry. However, the burden of proof and convince lawmakers about the incompatibility of certain project with the Medium Term Fiscal Framework lies with the Minister of Finance.
Moreover, we must reiterate that if the Ministry of Finance does not participate in the course of the project during its formation in the Congress, it can hardly mean that the legislative process is flawed by not taking into account the conditions set out in Article 819 of the Law on the 7th of 2003. Since the main burden in the presentation of the tax consequences of the project lies with the Ministry of Finance, the Ministry omission to inform lawmakers about the problems It presents the project does not affect the validity of the legislative process and vitiates the applicable law ".
Then in Judgment C-315 of 2008 (April 9), MP Jaime Córdoba Triviño, where presidential objections to Bill No. 18 of 2006 Senate were analyzed, 207 of 2007 House, "for which rebates are established the penalties for remiss of compulsory military service ", the corporation synthesized the following rules regarding the content and scope of the forecast of the fiscal impact into bills:

- The obligations under Article 7 of Law 819/03 constitute a parameter of legislative rationality, which aims to meet constitutionally valuable purposes, including the order of public finances, macroeconomic stability and effective implementation of laws. The latter as a preliminary study of the compatibility between the content of the bill and projections of economic policy, reduces the margin of uncertainty regarding the physical implementation of legislative provisions.
- The mandate of adequacy between justification of bills and planning of economic policy, however, can not be understood as a procedural requirement for the adoption of legislative initiatives, compliance with which should lie solely in Congress. This in both (i) Congress lacks the technical assessment bodies to determine the fiscal impact of each project, identifying additional sources of funding and support for the medium-term fiscal framework; and (ii) accept an interpretation of this nature would be an unreasonable burden for the Legislator and a correlative grant veto power to the Executive, through the Ministry of Finance, regarding the competence of Congress to make laws. A power of this character, which involves a barrier in the constitutional role of normative production, shown incompatible with the balance between the public authorities and the democratic principle.
- Considering the mandate as a legislative mechanism rationality, compliance initially corresponds to the Ministry of Finance and Public Credit, once Congress has valued using the tools at its disposal, compatibility between expenses it generates the legislative initiative and projections of economic policy laid down by the Government. Thus, if the government considers that the Chambers have carried out a fiscal impact analysis wrong, it corresponds to MOFTEC duty to attend the legislative procedure, in order to illustrate to Congress on the economic consequences of the project.
- Article 7 of Law 819/03 can not be interpreted in such a way that the lack of concurrence of the Ministry of Finance and Public Credit in the legislative process, affecting the constitutional validity of the respective process ".
As regards compliance with the requirement in the 7th article of the Law 819 of 2003, most recently in Judgment C-1197, 2008 (December 4), MP Nilson Pinilla Pinilla, this Court stated:
"By fixing the meaning and scope of the requirement in question, the Court has not sought anything other than setting the roles of Government and Congress on the analysis of the fiscal impact of proposals on public spending, making clear that the leading role corresponds to the first, as is forced to illustrate and prevent the economic implications of the proposal, without the development of this work come to represent a veto or obstacle in approving the project.
9. Thus, Government and Congress are called to meet the requirement under Article on the 7th of Law 819 of 2003, as set out in case law, having the first act on the basis of the proposal made by the legislative chambers. But to give by fulfilled the requirement under Article 7 of Law 819 of 2003, the Government is not enough to inform Congress the existence of difficulties in budget order, but must sustain and quantified based on technical studies, what is the incongruity argues the bill with "fiscal prospects that the nation has set for the next four years".
10. If Congress does not attend to the fulfillment of this requirement explicit the fiscal impact of the proposed public spending and the funding source, as indicated in that provision, ignoring the technical report made by the Ministry of Finance and Public Credit , a procedural error in the processing of the bill that may eventually bring about its unconstitutionality is generated, since it would be against the failure of an organic standard conditioning of legislative activity under the terms indicated in Article 151 superior ".
In the case under review, the Court observes that in the preamble to the bill number 2007 094 Senate [25], filed on October 18, 2006 to the Secretary of that corporation (f. . 454 cd initial), Congressman Ivan Moreno Germán Rojas, justified the initiative that aims to guarantee the right to life of children with cancer in Colombia, with the following financial reasons:

"It is estimated that on average, the monthly cost of a child suffering from cancer, is in the order of $ 2,000,000. Assuming an incidence of 1,000 patients a year in Colombia, and an average duration of 24 months treatment, the total cost would amount to $ 4,000 million per month and $ 48,000 million a year.
According to the response of the Ministry of Social Protection, health from the Promotion and Disease Prevention, until the last level of care is covered by Capitation Payment Units both contributory and subsidized and what not covered by these by the Sub-Account Catastrophic Events, ECAT, the Solidarity and Guarantee Fund, Fosyga.
We therefore consider that the treatment of Childhood Cancer in Colombia are guaranteed and what is required is to adapt the models of care, administrative regarding the opportunity of authorizations, drug supply quality aspects, service delivery and especially Care Units, which should be appropriate according to conditions which are referred to in technical annex to the bill.
While Childhood Cancer existing units will require adjustments and investments in infrastructure or provision, the bill provides for a review of existing tariffs and the possibility that with the support of the Advisory Councils resources are managed national and international cooperation, to encourage the empowerment of Units Childhood Cancer in Colombia, according to the population needs and regionalization incurred by the Ministry of Social Protection "[26].
The project was delivered to the Commission Seventh Constitutional Standing Senate of the Republic (d. 364), which approved in first debate on 13 May 2007 (f. 243. cd. Initial), based on the respectively [27] paper which reproduced, in essence, the arguments set forth in the preamble, noting, with regard to the financing of the proposal, that "it is estimated that the average total cost of a child with cancer is by the order of 80 million "; the plenary session of the corporation in the July 17, 2008 (f. 177 cd. Initial) approved the initiative with the same justification.
In the House of Representatives, under number 336 of 2008, the project under review was adopted by the Seventh Committee at its meeting of September 2, 2008 (fs. 110 and 111 cd. Initial), welcoming the proposals contained in the respective paper [28]. The project took second debate in the plenary of the same legislative [29] cell, being discussed and approved at the relevant meeting of November 4, 2008 (f. 63 cd. Initial).
In the process of the initiative involved the ministers of Social Welfare and Finance, who in communication September 9, 2008 (f. 124 cd. Initial), reiterated by the second of these offices by office of October 20 the same year (.. f 67 cd initial) submitted the following comments on the financial aspect of the project:
"... although in principle might think that is neutral financial effect of legislative initiative in this matter, truth is that from the wording and scope of the proposed items, can not reach this conclusion ... the legislative initiative not only involves technology for the treatment of disease but also conditions of different quality than those in the can currently finance the system and even the country ... it is eliminated completely the criterion of rationality and efficiency regarding the provision of services not included in the POS must be accompanied by the lack of ability to pay of the population, alternatives more cost effectiveness etc. Issues to consider also, as the right to health is essential although neither absolute nor unlimited, as seems to arise in this bill for this condition.
... So the extension of the Compulsory Health Plan - POS, of the two regimes, which is what ultimately generates the bill in question, without regard to criteria for the existence of resources to finance or cost effectiveness, care of the most significant risks to the population, quality measurement and technology available in the country, among others, affects the balance system, balance is poor for Contributory scheme, as resources collected by the subaccount Compensation barely cover the current annual expenditure represented by the UPC to be recognized by each member, by age group, and spending representing recoveries on account of guardianships and Technical Committees Scientists, that compromise significantly the availability of resources Fosyga " .

It is appreciated that the Government does not support or quantify, based on technical studies, what is the incongruity of the bill with the fiscal outlook that the nation has set for the next four years; ie does assessment of the fiscal impact of the initiative, but merely to raise in the abstract that the bill reference alters the financial balance of the Social Security System in Health, thus ignoring the obligation under Article the 7th of Law 819 of 2003, to "pay concept" on the fiscal viability of the initiative; also offered the support and technical illustration on the economic consequences of the project, governmental omission, as was narrowed above, it can not become insurmountable for the independent exercise of the legislative function by the Congress obstacle Congress.
As this Court has stated [30], the performance of the Ministry of Finance and Public Credit is due and is subject to duty laid down in Article 819 of the Law on the 7th of 2003 to deliver an opinion on the fiscal impact of bills on public spending; obligation, as it has clarified the law, can hardly be left alone at the head of the legislative body, which in this case it his duty to make an estimate of the fiscal cost of the initiative, both in the preamble and in the presentations.
It must be remembered that on previous occasions where this same point was analyzed, the Court declared unfounded the objection by the Executive to find that the legislative chambers had justified and analyzed the fiscal impact of the project and the government "expressly", meanwhile , had failed to comply with the obligation to conceptualise on the economic effects of the proposal or had intervened without providing a detailed, sustained and concrete of this impact study, as happens in the case which is discussed [31].
For all this, there is no doubt that this Court in approving the revision bill, Congress did not make a habit of unconstitutionality alleging breach the mandate of the 7th article of the Law 819 of 2003, reason for which he will dismiss the objection raised in that regard by the Government.
4.4. Objection to article 5 of the project
According to the Government, the 5th article of the bill denies the right to free enterprise of the IPS of private (article 333 Const.), Forcing all belonging to levels III or IV to form care Units Childhood Cancer, UACAI, forgetting that his specialty might be interested in attending different pathologies decision to be adopted by Congress without further analysis, also it violates the constitutional principle of efficiency in the provision of health services (Article 49 ib.)
for Cameras reproach is unfounded, because the standard does not establish an obligation for all IPS but only with respect to those who want to offer services and pediatric onco-hematology belong to III or IV levels of complexity, for such institutions to have intensive care units are able to ensure appropriate care for children with cancer.
The objection is not called to prosper, for the following reasons:
The approach of the Executive ignores the constitutional basis of the provision of health by individuals and also the jurisprudence of this corporation has repeatedly stated that the model mixed adopted by the legislature, which attend the state and individuals, it operates in an environment of economic freedom which primarily seeks to "private initiative is channeled towards the objectives of social interest and that the benefits of free competition and rationality in the allocation of own resources of a system of free enterprise, are translated into expanding coverage and improving the quality of services "[32].

For the Court the exercise of economic freedom and free competition in health, "can only occur within the scope that the legislature has provided for the purpose, and within the stringent standards of regulation, monitoring and control They are stemming from the constitutional responsibility that the state has in this social sector "[33]; therefore, it considered that the State intervention in this field is intense and develops under the principles of the rule of law, higher standards that authorize the intervention, with the corresponding limitation of economic freedom (Articles 150 -21, 333 and 334 Const.), and those relating to the regulation and inspection of the professions (Article 26 ib.), state intervention in public services (section 365 ib.) and health care in particular (articles 48, 49 ib.) [34].
According to the corporation, because it is an activity in which money from General Health System are handled by private companies, "state control preserves public trust, it allows these entities to have an administrative structure, technical, financial and professional to ensure regular, continuous and efficient delivery of health services to members "[35].
As regards the meaning of the principle of efficiency in the provision of social security health, jurisprudence has expressed that concept, "turns out to be much broader than simple technical and economic efficiencies, since it involves the providing an essential public service, as is health, which in turn is a constitutional right and is interrelated with other values, principles and fundamental rights. The provision of the health service in Colombia can not be understood as a simple 'health market', governed by the laws of supply and demand. The guarantee of economic, social and cultural rights does not depend on criteria simple utility or private economic advantage "[36].
Court has, however, noted that while freedom of enterprise supports limits imposed by intervening in the economy that is carried out by rule of law to fulfill the purposes of general interest that the Constitution mentions, "this intervention can not root out that freedom and must obey criteria of reasonableness and proportionality" [37]; for this reason it has been considered [38] that such intervention i) must necessarily be carried out by Ministry of Law; ii) can not affect the core of free enterprise; iii) must obey adequate and sufficient reasons for the limitation of that guarantee; iv) must obey the principle of solidarity; v) must meet criteria of reasonableness and proportionality.
Under these premises, finds this unreasonable Court's determination in article 5 under study because it pursues the activity of individuals providing public health service, for the IPS case, meets superordinate goals such as expanding coverage and improving the quality of health services (Article 49 Const.); the measure is not disproportionate because, as explained by the legislative chambers, the obligation to have Care Units Childhood Cancer, UACAI not agree to all private IPS but falls to levels III or IV of complexity, which they are those with intensive care units and therefore have the capacity to provide the services of onco-hematology pediatric to children with cancer, which meets the constitutional mandate to provide better social security service to a population vulnerable, minors (articles 13, 46, 49 and 365 ib.).

It is a measure adjusted to the Constitution intervention, since it is carried out by means of a law passed by Congress; It does not affect the core of the free enterprise of individuals who own IPS, since as we have seen, involves only those with technical skills to offer cancer treatment; It is based on reasons of solidarity with people considered subjects of special constitutional protection, minors, who must be assured with prevalent character, among other fundamental rights, life, physical integrity, health and social security ( articles 1 and 44 Const.); and finally addresses the criterion of efficiency in the provision of health service that it aims to take better advantage of the technical and scientific platform IPs on which rests the obligation to implement the Care Units Childhood Cancer, UACAI.
Based on the above reasons, the Court declared unfounded the objections of unconstitutionality made by the National Government to Bill number 2007 094 Senate and 336 House 2008, "for the right to life of children with cancer in Colombia "and, consequently, it declares constitutional the said project.
VIII. DECISION
In light of the foregoing, the Constitutional Court of the Republic of Colombia, administering justice on behalf of the people and by mandate of the Constitution, Resolves
:
First. Declare unfounded the objections of unconstitutionality made by the National Government to Draft Law No. 094 of 2007 Senate 336 2008 House, "for the right to life of children with cancer in Colombia" and therefore only respect them , declaring constitutional the said project.
Second. It refrain from taking a decision on the merits regarding the presidential objection based on the "dismantling" the General System of Social Security in Health, because of the lack of sufficient to make a judgment of constitutionality on the subject reasons, as expressed in the 4.2 fundamentals. and 4.2.1. of this decision.
Notifíquese, please insert in the Gazette of the Constitutional Court and filed the record. Cúmplase.
Nilson Pinilla Pinilla, President; Juan Carlos Henao Pérez, María Victoria Street Correa, Luis Ernesto Vargas Silva, Gabriel Eduardo Mendoza Martelo, Mauricio Gonzalez Cuervo, Jorge Ignacio Pretelt Chaljub, Humberto Antonio Sierra Porto, Jorge Ivan Palacio Palacio, Judges; Martha Victoria Sáchica of Moncaleano, General Secretary. (Judgment C-850/09) * * *

1 Cf. C-887, 2007 (October 24), MP Nilson Pinilla Pinilla, among others.
2 Cf. C-923 of 2000 (July 19), MP José Gregorio Hernández.; C-1249, 2001 (November 28), MP Marco Gerardo Monroy Cabra and C-070 2004 (February 3), MP Clara Inés Vargas Hernández, among others.
3 Cf. C-268 of 1995 (June 22) and C-380 of 1995 (August 30), M P. Vladimiro Naranjo Mesa.; C-292 of 1996 (July 4), MP Julio Cesar Ortiz and C-028 of 1997 (January 30), MP Alejandro Martinez Caballero.
4 Auto 311 2006 (November 8), MP Marco Gerardo Monroy Cabra.
5 Article 8 of Legislative Act 01 of 2003 provides: "No bill will be voted differently from that which has previously been announced session. Notice that a project will be put to the vote will give the presidency of each chamber or commission in separate session to one in which the vote will take place. "
6 C-576 of 2006 (July 25), MP Manuel José Cepeda Espinosa. SV Jaime Araújo Rentería. 7 C-256
1997 (May 28), MP José Gregorio Hernández Galindo.
8 C-646, 2001 (June 20), MP Manuel José Cepeda Espinosa.
9 C-687, 2002 (August 27), Eduardo Montealegre MP Lynett. 10 C-646
2001
11 C-687
2002. 12 C-319, 2006 (April 25), Alvaro Tafur Galvis MP.
13 C-510, 2008 (May 21), MP Manuel José Cepeda Espinosa.
C-865 14 2001 (August 15), Eduardo Montealegre MP Lynett.
15 Cf. 2003 C-650, C-482 and C-256 2002 1997.
16 "In any case, the judge will set the other effects of the judgment for the case and keep competition up it is fully restored the right or eliminated the causes of the threat. "
C-1489 17 2000 (November 2), Alejandro Martinez Caballero MP
C-033 18 1999 (January 27), MP Carlos Gaviria Diaz; C-1041, 2007 (December 4), MP Humberto Antonio Sierra Porto. 19 C-463
2008 (May 14), MP Jaime Araújo Rentería.
20 C-623, 2004, MP Rodrigo Escobar Gil.
21 C-671, 2002, MP Eduardo Montealegre Lynett. 22 C-671
2002
23 C-662/09 (September 22), MP Luis Ernesto Vargas Silva.

24 Cf. C-947 of 1999 (December 1), MP José Gregorio Hernández Galindo.; C-911, 2007 (October 31), MP Jaime Araújo Rentería.
25 Published in the Congress Gazette number 406 of August 27, 2007. October 26
Congress Gazette number 406 of August 27, 2007. October 27
Congress Gazette number 631 of December 5
2007. 28 Gazette 256th Congress June 7, 2007, page 10. 29
Congress Gazette number 706 of 10 October 2008. 30 C-1197
2008 (December 4) MP Nilson Pinilla Pinilla. 31 C-315
2008 (April 9), MP Jaime Córdoba Triviño and C-1141, 2008 (November 19), MP Humberto Antonio Sierra Porto. 32 C-974
2002 (November 13), Rodrigo Escobar Gil MP. 33 C-616
2001 (June 13), Rodrigo Escobar Gil MP.
34 Ib.
35 Ib.
36 C-1041, 2007 (December 4), MP Humberto Antonio Sierra Porto.
37 Ib. 38 C-615
2002 (August 8), MP Marco Gerardo Monroy Cabra.


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