Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050

Financial resources are an essential input to health systems—at a minimum, these are necessary to purchase medicines and supplies, build health facilities, and pay health workers. However, limited financial resources are a universal constraint faced by all health systems. WHO has identified health f...

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Autores:
Y Chang, Angela
Cowling, Krycia
Micah, Angela E.
Chapin, Abigail
Chen, Catherine S
Alvis-Guzman, Nelson
Tipo de recurso:
Article of journal
Fecha de publicación:
2019
Institución:
Corporación Universidad de la Costa
Repositorio:
REDICUC - Repositorio CUC
Idioma:
eng
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oai:repositorio.cuc.edu.co:11323/4664
Acceso en línea:
https://hdl.handle.net/11323/4664
https://repositorio.cuc.edu.co/
Palabra clave:
Recursos financieros
Sistemas de salud
Financial resources
Systems of health
Rights
openAccess
License
http://creativecommons.org/licenses/by-nc-sa/4.0/
id RCUC2_b9f896feb61f14092a7a68eb8f08097f
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network_name_str REDICUC - Repositorio CUC
repository_id_str
dc.title.spa.fl_str_mv Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050
dc.title.translated.spa.fl_str_mv Pasado, presente y futuro de la financiación sanitaria mundial: una revisión de la asistencia para el desarrollo, los gastos del gobierno, los desembolsos y otros gastos privados en salud para 195 países, 1995–2050
title Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050
spellingShingle Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050
Recursos financieros
Sistemas de salud
Financial resources
Systems of health
title_short Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050
title_full Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050
title_fullStr Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050
title_full_unstemmed Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050
title_sort Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050
dc.creator.fl_str_mv Y Chang, Angela
Cowling, Krycia
Micah, Angela E.
Chapin, Abigail
Chen, Catherine S
Alvis-Guzman, Nelson
dc.contributor.author.spa.fl_str_mv Y Chang, Angela
Cowling, Krycia
Micah, Angela E.
Chapin, Abigail
Chen, Catherine S
Alvis-Guzman, Nelson
dc.subject.spa.fl_str_mv Recursos financieros
Sistemas de salud
Financial resources
Systems of health
topic Recursos financieros
Sistemas de salud
Financial resources
Systems of health
description Financial resources are an essential input to health systems—at a minimum, these are necessary to purchase medicines and supplies, build health facilities, and pay health workers. However, limited financial resources are a universal constraint faced by all health systems. WHO has identified health financing as one of the six key building blocks of health systems and adequate financing is essential to the other five blocks.1 Health financing systems are tasked not only with raising sufficient financial resources to fund the health system, but doing so in a way that promotes equity.2 Health systems funded according to one's ability to pay, such as those based on income taxes, promote both financial equity and better health.3 Over-reliance on out-of-pocket spending diminishes access to care for those who are uninsured or underinsured, and risks exacerbating the burden of ill health and increasing poverty due to the high cost of care.4 The recognised importance of financial protection has led to its inclusion as one of two pillars of universal health coverage, alongside coverage of core health services, as outlined in Sustainable Development Goal 3.
publishDate 2019
dc.date.accessioned.none.fl_str_mv 2019-05-22T12:44:56Z
dc.date.available.none.fl_str_mv 2019-05-22T12:44:56Z
dc.date.issued.none.fl_str_mv 2019
dc.type.spa.fl_str_mv Artículo de revista
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dc.identifier.instname.spa.fl_str_mv Corporación Universidad de la Costa
dc.identifier.reponame.spa.fl_str_mv REDICUC - Repositorio CUC
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identifier_str_mv Corporación Universidad de la Costa
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dc.relation.ispartof.spa.fl_str_mv DOI:https://doi.org/10.1016/S0140-6736(19)30841-4
dc.relation.references.spa.fl_str_mv 1 WHO. World Health Report 2010—health systems financing: the path to universal coverage. WHO, 2010. https://www.who.int/ whr/2010/en/ (accessed Dec 21, 2018).
2 Gottret P, Schieber G. Health financing revisited: a practioner’s guide. Washington, DC: The International Bank for Reconstruction and Development/The World Bank, 2006. https://openknowledge. worldbank.org/handle/10986/7094 (accessed March 6, 2019).
3 Reeves A, Gourtsoyannis Y, Basu S, McCoy D, McKee M, Stuckler D. Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries. Lancet 2015; 386: 274–80.
4 Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. Lancet 2003; 362: 111–17.
5 Bokhari FAS, Gai Y, Gottret P. Government health expenditures and health outcomes. Health Econ 2007; 16: 257–73.
6 Moreno-Serra R, Smith PC. Broader health coverage is good for the nation’s health: evidence from country level panel data. J R Stat Soc Ser A Stat Soc 2015; 178: 101–24.
7 Nixon J, Ulmann P. The relationship between health care expenditure and health outcomes. Evidence and caveats for a causal link. Eur J Health Econ 2006; 7: 7–18.
8 Budhdeo S, Watkins J, Atun R, Williams C, Zeltner T, Maruthappu M. Changes in government spending on healthcare and population mortality in the European union, 1995–2010: a cross-sectional ecological study. J R Soc Med 2015; 108: 490–98.
9 Dieleman JL, Sadat N, Chang AY, et al. Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40. Lancet 2018; 391: 1783–98.
10 Cashin C. Health financing policy: the macroeconomic, fiscal, and public finance context. Washington, DC: International Bank for Reconstruction and Development/The World Bank, 2016.
11 Mann C, Ng C, Akseer N, et al. Countdown to 2015 country case studies: what can analysis of national health financing contribute to understanding MDG 4 and 5 progress? BMC Public Health 2016; 16 (suppl 2): 792.
12 WHO. Global health expenditure database. Last updated March 22, 2019. http://www.who.int/health-accounts/ghed/en/ (accessed Dec 21, 2018).
13 OECD, Eurostat, WHO. A system of health accounts 2011: revised edition. Paris: OECD Publishing, 2017. https://read.oecdilibrary. org/social-issues-migration-health/a-system-of-healthaccounts- 2011_9789264270985-en (accessed March 7, 2019).
14 Feenstra RC, Inklaar R, Marcel P. The next generation of the Penn World Table. Am Econ Rev 2015; 105: 3150–82. Available for download at: https://www.rug.nl/ggdc/productivity/pwt/ (accessed Dec 21, 2018).
15 World Bank. World Bank country and lending groups—World Bank data help desk. https://datahelpdesk.worldbank.org/knowledgebase/ articles/906519-world-bank-country-and-lending-groups (accessed Dec 21, 2018).
16 International Monetary Fund. World economic outlook, October 2018: challenges to steady growth. https://www.imf.org/en/Publications/ WEO/Issues/2018/09/24/world-economic-outlook-october-2018 (accessed Dec 21, 2018).
17 Jutta B, Inklaar R, de Jong H, van Zanden JL. Maddison Project Database, version 2018. Rebasing ‘Maddison’: new income comparisons and the shape of long-run economic development. Maddison Project Working paper 10. January, 2018. https://www.rug. nl/ggdc/historicaldevelopment/maddison/releases/maddisonproject- database-2018 (accessed Dec 21, 2018).
18 UN Statistics Division. National Accounts Main Aggregates Database. —National Health Accounts. https://unstats.un.org/ unsd/snaama/Introduction.asp (accessed Dec 21, 2018).
19 James SL, Gubbins P, Murray CJ, Gakidou E. Developing a comprehensive time series of GDP per capita for 210 countries from 1950 to 2015. Pop Health Metrics 2012; 10: 12.
20 GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1659–724.
21 Ravishankar N, Gubbins P, Cooley RJ, et al. Financing of global health: tracking development assistance for health from 1990 to 2007. Lancet 2009; 373: 2113–24.
22 Leach-Kemon K, Chou DP, Schneider MT, et al. The global financial crisis has led to a slowdown in growth of funding to improve health in many developing countries. Health Aff 2012; 31: 228–35.
23 Dieleman JL, Graves C, Johnson E, et al. Sources and focus of health development assistance, 1990–2014. JAMA 2015; 313: 2359–68.
24 Dieleman JL, Graves CM, Templin T, et al. Global health development assistance remained steady in 2013 but did not align with recipients’ disease burden. Health Aff 2014; 33: 878–86.
25 Dieleman JL, Templin T, Sadat N, et al. National spending on health by source for 184 countries between 2013 and 2040. Lancet 2016; 387: 2521–35.
26 Das Gupta P. Standardization and decompostion of rates: a user’s manual. US Bureau of the Census, 1993. https://www.census.gov/ content/dam/Census/library/publications/1993/demo/p23-186.pdf (accessed Dec 21, 2018).
27 Foreman KJ, Lozano R, Lopez AD, Murray CJ. Modeling causes of death: an integrated approach using CODEm. Population Health Metrics 2012; 10: 1.
28 UN Department of Economic and Social Affairs. World Population Prospects: the 2017 revision. June 21, 2017. https://www.un.org/ development/desa/publications/world-population-prospects-the- 2017-revision.html (accessed Dec 21, 2018).
29 The World Bank. World Bank Country and Lending Groups— World Bank Data Help Desk. https://datahelpdesk.worldbank.org/ knowledgebase/articles/906519-world-bank-country-and-lendinggroups (accessed Dec 21, 2018).
30 Abate KH, Abay SM, Abbafati C, et al. Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1684–735.
31 Fan VY, Savedoff WD. The health financing transition: a conceptual framework and empirical evidence. Soc Sci Med 2014; 105: 112–21.
32 Evans DB, Etienne C. Health systems financing and the path to universal coverage. Bull World Health Organ 2010; 88: 402–03.
33 Leive A, Xu K. Coping with out-of-pocket health payments: empirical evidence from 15 African countries. Bull World Health Organ 2008; 86: 849–56C.
34 Xu K, Soucat A, Kutzin J, et al. Public spending on health: a closer look at global trends. 2018. https://www.who.int/health_financing/ documents/health-expenditure-report-2018/en/ (accessed Dec 22, 2018).
35 Reeves A, Gourtsoyannis Y, Basu S, McCoy D, McKee M, Stuckler D. Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries. Lancet 2015; 386: 274–80.
36 Dercon S, Lea N. The missing middle—or is there an obvious resource gap for LMICs? May, 2015. https://studylib.net/ doc/13003145/the-missing-middle (accessed Dec 21, 2018).
37 GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1736–88.
38 Huang Y. China’s response to the 2014 Ebola outbreak in West Africa. Global Challenges 2017; published online Jan 30. DOI:10.1002/gch2.201600001.
39 Alcorn T. New orientation for China’s health assistance to Africa. Lancet 2015; 386: 2379–80.
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spelling Y Chang, AngelaCowling, KryciaMicah, Angela E.Chapin, AbigailChen, Catherine SAlvis-Guzman, Nelson2019-05-22T12:44:56Z2019-05-22T12:44:56Z2019https://hdl.handle.net/11323/4664Corporación Universidad de la CostaREDICUC - Repositorio CUChttps://repositorio.cuc.edu.co/Financial resources are an essential input to health systems—at a minimum, these are necessary to purchase medicines and supplies, build health facilities, and pay health workers. However, limited financial resources are a universal constraint faced by all health systems. WHO has identified health financing as one of the six key building blocks of health systems and adequate financing is essential to the other five blocks.1 Health financing systems are tasked not only with raising sufficient financial resources to fund the health system, but doing so in a way that promotes equity.2 Health systems funded according to one's ability to pay, such as those based on income taxes, promote both financial equity and better health.3 Over-reliance on out-of-pocket spending diminishes access to care for those who are uninsured or underinsured, and risks exacerbating the burden of ill health and increasing poverty due to the high cost of care.4 The recognised importance of financial protection has led to its inclusion as one of two pillars of universal health coverage, alongside coverage of core health services, as outlined in Sustainable Development Goal 3.Los recursos financieros son un insumo esencial para los sistemas de salud; como mínimo, son necesarios para comprar medicamentos y suministros, construir instalaciones de salud y pagar a los trabajadores de salud. Sin embargo, los recursos financieros limitados son una restricción universal que enfrentan todos los sistemas de salud. La OMS ha identificado el financiamiento de la salud como uno de los seis componentes clave de los sistemas de salud, y un financiamiento adecuado es esencial para los otros cinco bloques.1 Los sistemas de financiamiento de la salud tienen la tarea no solo de recaudar recursos financieros suficientes para financiar el sistema de salud, sino también de hacerlo. una forma que promueve la equidad.2 Los sistemas de salud financiados de acuerdo con la capacidad de pago de una persona, como los que se basan en impuestos a la renta, promueven tanto la equidad financiera como una mejor salud.3 La excesiva dependencia de los gastos de bolsillo disminuye el acceso a la atención para aquellos quienes no tienen seguro o tienen un seguro insuficiente, y los riesgos que exacerban la carga de la mala salud y el aumento de la pobreza debido al alto costo de la atención4. La importancia reconocida de la protección financiera ha llevado a su inclusión como uno de los dos pilares de la cobertura de salud universal, junto con la cobertura de servicios básicos de salud, tal como se describe en el Objetivo 3 de Desarrollo Sostenible.Y Chang, Angela-625e055f-b21f-46a4-9614-e8dfc9821a21-0Cowling, Krycia-67808306-d55e-4a89-b1af-8579fbb60d5f-0Micah, Angela E.-d4189f43-1f5d-43f0-a064-161fce1ea0c2-0Chapin, Abigail-4918d6c7-bd76-42dd-b730-a45f9f948507-0Chen, Catherine S-89291156-bdba-47ab-b67d-601f1bbec57f-0Alvis-Guzman, NelsonengThe LancetDOI:https://doi.org/10.1016/S0140-6736(19)30841-41 WHO. World Health Report 2010—health systems financing: the path to universal coverage. WHO, 2010. https://www.who.int/ whr/2010/en/ (accessed Dec 21, 2018).2 Gottret P, Schieber G. Health financing revisited: a practioner’s guide. Washington, DC: The International Bank for Reconstruction and Development/The World Bank, 2006. https://openknowledge. worldbank.org/handle/10986/7094 (accessed March 6, 2019).3 Reeves A, Gourtsoyannis Y, Basu S, McCoy D, McKee M, Stuckler D. Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries. Lancet 2015; 386: 274–80.4 Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household catastrophic health expenditure: a multicountry analysis. Lancet 2003; 362: 111–17.5 Bokhari FAS, Gai Y, Gottret P. Government health expenditures and health outcomes. Health Econ 2007; 16: 257–73.6 Moreno-Serra R, Smith PC. Broader health coverage is good for the nation’s health: evidence from country level panel data. J R Stat Soc Ser A Stat Soc 2015; 178: 101–24.7 Nixon J, Ulmann P. The relationship between health care expenditure and health outcomes. Evidence and caveats for a causal link. Eur J Health Econ 2006; 7: 7–18.8 Budhdeo S, Watkins J, Atun R, Williams C, Zeltner T, Maruthappu M. Changes in government spending on healthcare and population mortality in the European union, 1995–2010: a cross-sectional ecological study. J R Soc Med 2015; 108: 490–98.9 Dieleman JL, Sadat N, Chang AY, et al. Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40. Lancet 2018; 391: 1783–98.10 Cashin C. Health financing policy: the macroeconomic, fiscal, and public finance context. Washington, DC: International Bank for Reconstruction and Development/The World Bank, 2016.11 Mann C, Ng C, Akseer N, et al. Countdown to 2015 country case studies: what can analysis of national health financing contribute to understanding MDG 4 and 5 progress? BMC Public Health 2016; 16 (suppl 2): 792.12 WHO. Global health expenditure database. Last updated March 22, 2019. http://www.who.int/health-accounts/ghed/en/ (accessed Dec 21, 2018).13 OECD, Eurostat, WHO. A system of health accounts 2011: revised edition. Paris: OECD Publishing, 2017. https://read.oecdilibrary. org/social-issues-migration-health/a-system-of-healthaccounts- 2011_9789264270985-en (accessed March 7, 2019).14 Feenstra RC, Inklaar R, Marcel P. The next generation of the Penn World Table. Am Econ Rev 2015; 105: 3150–82. Available for download at: https://www.rug.nl/ggdc/productivity/pwt/ (accessed Dec 21, 2018).15 World Bank. World Bank country and lending groups—World Bank data help desk. https://datahelpdesk.worldbank.org/knowledgebase/ articles/906519-world-bank-country-and-lending-groups (accessed Dec 21, 2018).16 International Monetary Fund. World economic outlook, October 2018: challenges to steady growth. https://www.imf.org/en/Publications/ WEO/Issues/2018/09/24/world-economic-outlook-october-2018 (accessed Dec 21, 2018).17 Jutta B, Inklaar R, de Jong H, van Zanden JL. Maddison Project Database, version 2018. Rebasing ‘Maddison’: new income comparisons and the shape of long-run economic development. Maddison Project Working paper 10. January, 2018. https://www.rug. nl/ggdc/historicaldevelopment/maddison/releases/maddisonproject- database-2018 (accessed Dec 21, 2018).18 UN Statistics Division. National Accounts Main Aggregates Database. —National Health Accounts. https://unstats.un.org/ unsd/snaama/Introduction.asp (accessed Dec 21, 2018).19 James SL, Gubbins P, Murray CJ, Gakidou E. Developing a comprehensive time series of GDP per capita for 210 countries from 1950 to 2015. Pop Health Metrics 2012; 10: 12.20 GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388: 1659–724.21 Ravishankar N, Gubbins P, Cooley RJ, et al. Financing of global health: tracking development assistance for health from 1990 to 2007. Lancet 2009; 373: 2113–24.22 Leach-Kemon K, Chou DP, Schneider MT, et al. The global financial crisis has led to a slowdown in growth of funding to improve health in many developing countries. Health Aff 2012; 31: 228–35.23 Dieleman JL, Graves C, Johnson E, et al. Sources and focus of health development assistance, 1990–2014. JAMA 2015; 313: 2359–68.24 Dieleman JL, Graves CM, Templin T, et al. Global health development assistance remained steady in 2013 but did not align with recipients’ disease burden. Health Aff 2014; 33: 878–86.25 Dieleman JL, Templin T, Sadat N, et al. National spending on health by source for 184 countries between 2013 and 2040. Lancet 2016; 387: 2521–35.26 Das Gupta P. Standardization and decompostion of rates: a user’s manual. US Bureau of the Census, 1993. https://www.census.gov/ content/dam/Census/library/publications/1993/demo/p23-186.pdf (accessed Dec 21, 2018).27 Foreman KJ, Lozano R, Lopez AD, Murray CJ. Modeling causes of death: an integrated approach using CODEm. Population Health Metrics 2012; 10: 1.28 UN Department of Economic and Social Affairs. World Population Prospects: the 2017 revision. June 21, 2017. https://www.un.org/ development/desa/publications/world-population-prospects-the- 2017-revision.html (accessed Dec 21, 2018).29 The World Bank. World Bank Country and Lending Groups— World Bank Data Help Desk. https://datahelpdesk.worldbank.org/ knowledgebase/articles/906519-world-bank-country-and-lendinggroups (accessed Dec 21, 2018).30 Abate KH, Abay SM, Abbafati C, et al. Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1684–735.31 Fan VY, Savedoff WD. The health financing transition: a conceptual framework and empirical evidence. Soc Sci Med 2014; 105: 112–21.32 Evans DB, Etienne C. Health systems financing and the path to universal coverage. Bull World Health Organ 2010; 88: 402–03.33 Leive A, Xu K. Coping with out-of-pocket health payments: empirical evidence from 15 African countries. Bull World Health Organ 2008; 86: 849–56C.34 Xu K, Soucat A, Kutzin J, et al. Public spending on health: a closer look at global trends. 2018. https://www.who.int/health_financing/ documents/health-expenditure-report-2018/en/ (accessed Dec 22, 2018).35 Reeves A, Gourtsoyannis Y, Basu S, McCoy D, McKee M, Stuckler D. Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries. Lancet 2015; 386: 274–80.36 Dercon S, Lea N. The missing middle—or is there an obvious resource gap for LMICs? May, 2015. https://studylib.net/ doc/13003145/the-missing-middle (accessed Dec 21, 2018).37 GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1736–88.38 Huang Y. China’s response to the 2014 Ebola outbreak in West Africa. Global Challenges 2017; published online Jan 30. DOI:10.1002/gch2.201600001.39 Alcorn T. New orientation for China’s health assistance to Africa. Lancet 2015; 386: 2379–80.http://creativecommons.org/licenses/by-nc-sa/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Recursos financierosSistemas de saludFinancial resourcesSystems of healthPast, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050Pasado, presente y futuro de la financiación sanitaria mundial: una revisión de la asistencia para el desarrollo, los gastos del gobierno, los desembolsos y otros gastos privados en salud para 195 países, 1995–2050Artículo de revistahttp://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1Textinfo:eu-repo/semantics/articlehttp://purl.org/redcol/resource_type/ARTinfo:eu-repo/semantics/acceptedVersionPublicationORIGINALPast, present.pdfPast, present.pdfapplication/pdf6077758https://repositorio.cuc.edu.co/bitstreams/2c47fde0-4c41-4c2f-ae97-f89e2f3ed547/downloadaaac3944178e34c20cc214255f96312bMD51CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-81031https://repositorio.cuc.edu.co/bitstreams/ce5cbf42-886f-4ed3-8224-beed0cc4df26/download934f4ca17e109e0a05eaeaba504d7ce4MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-81748https://repositorio.cuc.edu.co/bitstreams/2a831980-9e8d-49fd-b1a0-edac734ed091/download8a4605be74aa9ea9d79846c1fba20a33MD53THUMBNAILPast, present.pdf.jpgPast, present.pdf.jpgimage/jpeg81314https://repositorio.cuc.edu.co/bitstreams/59fe2f44-7ec0-4799-b799-edbaebe028ef/download9044f42d7246f5685be707dfc3a19e5cMD55TEXTPast, present.pdf.txtPast, present.pdf.txttext/plain162405https://repositorio.cuc.edu.co/bitstreams/fb298c0b-c576-465f-808b-6964109b72a9/downloade761a14711bcccb3e81eba5e126ca673MD5611323/4664oai:repositorio.cuc.edu.co:11323/46642024-09-17 12:48:49.833http://creativecommons.org/licenses/by-nc-sa/4.0/open.accesshttps://repositorio.cuc.edu.coRepositorio de la Universidad de la Costa CUCrepdigital@cuc.edu.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