Loss ratio of the capitation payment unit of the health-promoting entities in Colombia between 2017 and 2021: a financial-actuarial approach

Oscar Espinosa; Jhonathan Rodríguez; B Piedad Urdinola; Pedro Luis Do Nascimento Silva; Alejandra Sánchez; Martha-Liliana Arias; Emiliano A Valdez; Terence Cheng; Sara-Ellison Fisher

doi:10.1186/s12962-023-00481-5

Loss ratio of the capitation payment unit of the health-promoting entities in Colombia between 2017 and 2021: a financial-actuarial approach

Cost Eff Resour Alloc. 2023 Oct 4;21(1):73. doi: 10.1186/s12962-023-00481-5.

Authors

Oscar Espinosa¹, Jhonathan Rodríguez², B Piedad Urdinola³, Pedro Luis Do Nascimento Silva⁴, Alejandra Sánchez⁵, Martha-Liliana Arias⁶, Emiliano A Valdez⁷, Terence Cheng⁸, Sara-Ellison Fisher⁹

Affiliations

¹ Research Group on Economic Models and Quantitative Methods, Centro de Investigaciones para el Desarrollo, Universidad Nacional de Colombia, Bogotá, Colombia. oaespinosaa@unal.edu.co.
² Research Group on Economic Models and Quantitative Methods, Centro de Investigaciones para el Desarrollo, Universidad Nacional de Colombia, Bogotá, Colombia.
³ General Directorate, Departamento Administrativo Nacional de Estadística, Bogotá, Colombia.
⁴ Escola Nacional de Ciências Estatísticas, Rio de Janeiro, Brasil.
⁵ Department of Mathematics, Universidad Nacional de Colombia, Bogotá, Colombia.
⁶ Department of Accounting Sciences, Pontificia Universidad Javeriana, Bogotá, Colombia.
⁷ Department of Mathematics, University of Connecticut, Mansfield, USA.
⁸ Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA.
⁹ Department of Economics, MIT, Boston, USA.

Abstract

Background: Because of a change of government, the Colombian Ministry of Health and Social Protection is in the process of presenting a structural reform for the General System of Social Security in Health (GSSSH), in order to implement a 'preventive and predictive health model'. However, it will always be relevant to review and analyze the fiscal implications of any proposed public policy program, to protect financial sustainability and to promote the better functioning of the system in question.

Methods: To contribute to this topic, we have calculated, using a financial-actuarial approach, the loss ratio for the years 2017 to 2021 for the Capitation Payment Unit (CPU) for all the Health-Promoting Entities (HPE) for both contributory and subsidized schemes. This information, derived from public reports available on the official website of the National Health Superintendency, allows us to estimate the financial burden of the institutions that guarantee access to and provision of health services and technologies in Colombia.

Results: The study shows that close to half of the HPEs in Colombia (which represent 11.6 million affiliates) have CPU loss ratios of more than 100% for the year 2021, evidencing insufficient resources for the operation of health insurance.

Conclusions: Finally, we propose some policy recommendations regarding the strengthening of informed decision-making to allow the healthy financial sustainability of the Colombian GSSSH.

Keywords: Actuarial sciences; Capitation Payment Unit; Colombia; General System of Social Security in Health; Health-Promoting Entities; Loss ratio.