Structural fragility of installed health-service capacity in Barranquilla, Colombia: an ecological study integrating capacity, concentration, reserve, and clinical sensitivity.

Objective: to characterize the structural fragility of installed health-service capacity in Barranquilla, Atlántico, by combining absolute capacity, market concentration, reserve/transitory capacity, and clinical sensitivity at the service-line level. Methods: ecological health-services study based on a local installed-capacity extract traceable to REPS/SISPRO and two World Bank context series for Colombia (physicians per 1,000 population and premature mortality from noncommunicable diseases) [1–6]. We applied traceable cleaning, functional normalization, separation of base versus transitory capacity when fields allowed it, and estimation of a relative proxy probability using a normalized Poisson approach. Results: total analytical capacity reached 5,397 slots; adult ICU contributed 707 slots and neonatal ICU 160. Reserve was low in neonatal ICU (2.5%) and higher in adult ICU (32.2%). The largest service lines were adult general hospitalization, adult ICU, and pediatric general hospitalization (Table 2; Fig. 1), whereas the highest relative fragility was concentrated in low-scale and high-concentration lines, including burn ICU, acute mental health, and some highly specialized lines (Table 3; Fig. 2). Conclusion: Barranquilla shows a broad structural network, but with marked heterogeneity across service lines. The critical pattern is not only volume; it is the combination of limited effective capacity, high concentration, and low stable slack. The evidence produced is structural and must not be interpreted as observed occupancy or actual saturation.