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This article proposes to analyze the dynamic of political contention during the implementation phase of health system reform in Colombia between 1995 and 2003. This article argues that the direction taken by the changes affected multiple actors in both instances the state as economic power to unions, international organizations, unions, political guilds, professional associations and divers organized groups. The narrative focuses on the debates and conflicts between the state and the societal actors in coalitions established, opportunities for social participation and its effects, the points of objection or defense to the reform and the influence of the correlation of forces in this process. [ABSTRACT FROM AUTHOR]