| Summary: | Objective: This paper presents one of the categories that emerged from a study carried out to achieve a comprehension of decisions related to delivering health services, within a restrictive environment offered by the Colombian Social Security System for Health. Methodology: The study was carried out in six cities of department, which conducted an average of 29 in-depth interviews by city, doctors, nurses and administrators (179 in total), belonging to 96 public and private health institutions. Also 10 focus groups with users of health services were carried out. Results: The nexus between the state institutions and the political parties is preset into the whole processes of provision of health services in the Colombian health system. With the decentralization process and the Social Security System for Health, the nexus between the political parties, the economic groups involved as health insurers and the political patronage have been strengthened, and they dominate and control the political, economical and administrative decisions of the health system. The Social Security System for Heath, as health policy, founded on neo-liberal approach, and the clientelistic practices of the political parties do not promote the public values rather than they promote private interests, which generates conflicts with the values and the citizen rights established in the Colombian Political Constitution of 1991.
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