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Progressive segmented health insurance: Colombian health reform and access to health services

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  • Fernando Ruiz
  • Liliana Amaya
  • Stella Venegas

Abstract

Equal access for poor populations to health services is a comprehensive objective for any health reform. The Colombian health reform addressed this issue through a segmented progressive social health insurance approach. The strategy was to assure universal coverage expanding the population covered through payroll linked insurance, and implementing a subsidized insurance program for the poorest populations, those not affiliated through formal employment. A prospective study was performed to follow‐up health service utilization and out‐of‐pocket expenses using a cohort design. It was representative of four Colombian cities (Cendex Health Services Use and Expenditure Study, 2001). A four part econometric model was applied. The model related medical service utilization and medication with different socioeconomic, geographic, and risk associated variables. Results showed that subsidized health insurance improves health service utilization and reduces the financial burden for the poorest, as compared to those non‐insured. Other social health insurance schemes preserved high utilization with variable out‐of‐pocket expenditures. Family and age conditions have significant effect on medical service utilization. Geographic variables play a significant role in hospital inpatient service utilization. Both, geographic and income variables also have significant impact on out‐of‐pocket expenses. Projected utilization rates and a simulation favor a dual policy for two‐stage income segmented insurance to progress towards the universal insurance goal. Copyright © 2006 John Wiley & Sons, Ltd.

Suggested Citation

  • Fernando Ruiz & Liliana Amaya & Stella Venegas, 2007. "Progressive segmented health insurance: Colombian health reform and access to health services," Health Economics, John Wiley & Sons, Ltd., vol. 16(1), pages 3-18, January.
    • Handle: RePEc:wly:hlthec:v:16:y:2007:i:1:p:3-18
    DOI: 10.1002/hec.1147
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    2. Pantig, Ida Marie T., 2015. "Sustainability of the National Government Premium Subsidy for Indigents," Philippine Journal of Development PJD 2013 Vol. 40 Nos. 1-2, Philippine Institute for Development Studies.
    3. Lan Thi Thu Phan & Yusuke Jinnai, 2018. "Does health insurance matter in the hospital? New evidence from patient-level medical records in Vietnam," Working Papers EMS_2018_01, Research Institute, International University of Japan.
    4. Randall P. Ellis & Juan Gabriel Fernandez, 2013. "Risk Selection, Risk Adjustment and Choice: Concepts and Lessons from the Americas," IJERPH, MDPI, vol. 10(11), pages 1-34, October.
    5. Garcia-Subirats, Irene & Vargas, Ingrid & Mogollón-Pérez, Amparo Susana & De Paepe, Pierre & da Silva, Maria Rejane Ferreira & Unger, Jean Pierre & Vázquez, María Luisa, 2014. "Barriers in access to healthcare in countries with different health systems. A cross-sectional study in municipalities of central Colombia and north-eastern Brazil," Social Science & Medicine, Elsevier, vol. 106(C), pages 204-213.
    6. Arrieta, Alejandro & García-Prado, Ariadna & Guillén, Jorge, 2011. "The Private Health Care Sector and the Provision of Prenatal Care Services in Latin America," World Development, Elsevier, vol. 39(4), pages 579-587, April.
    7. Hou, Xiaohui & Chao, Shiyan, 2011. "Targeted or untargeted? The initial assessment of a targeted health insurance program for the poor in Georgia," Health Policy, Elsevier, vol. 102(2), pages 278-285.
    8. Minh T. Nguyen, 2020. "Re‐examining the effects of public health insurance: The case of nonpoor children in Vietnam," Health Economics, John Wiley & Sons, Ltd., vol. 29(3), pages 294-305, March.
    9. Cesur, Resul & Gunes, Pinar Mine & Tekin, Erdal & Ulker, Aydogan, 2015. "The Value of Socialized Medicine: The Impact of Universal Primary Healthcare Provision on Birth and Mortality Rates in Turkey," IZA Discussion Papers 9329, Institute of Labor Economics (IZA).
    10. Riska Dwi Astuti & Rindang Nuri Isnaini Nugrohowati, 2022. "Impact evaluation of subsidized health insurance programs on utilization of healthcare facilities: evidence from Indonesia," International Journal of Health Economics and Management, Springer, vol. 22(3), pages 315-331, September.
    11. Jeannette Liliana Amaya & Fernando Ruiz & Antonio J. Trujillo & Christine Buttorff, 2016. "Identifying barriers to move to better health coverage: preferences for health insurance benefits among the rural poor population in La Guajira, Colombia," International Journal of Health Planning and Management, Wiley Blackwell, vol. 31(1), pages 126-138, January.
    12. Alejandro Arrieta & Ariadna García Prado & Giota Panopoulou, 2012. "Enrolling the Self-Employed in Mandatory Health Insurance in Colombia: are we missing other factors?," Documentos de Trabajo - Lan Gaiak Departamento de Economía - Universidad Pública de Navarra 1213, Departamento de Economía - Universidad Pública de Navarra.

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