Biased selection within the social health insurance market in Colombia
Reducing the impact of insurance market failures with regulations such as community-rated premiums, standardized benefit packages and open enrolment, yield limited impact because they create room for selection bias. The Colombian social health insurance system started a market approach in 1993 on the expectation to improve performance of preexisting monopolistic insurance funds by exposing them to competition by new entrants. It is hypothesized that market failures would lead to biased selection favoring new entrants. Two household surveys are analyzed using Self-reported health status and the presence of chronic conditions as indicators of prospective risk of enrolees. Biased selection is found to take place, leading to adverse selection among incumbents, and favorable selection among new entrants. This pattern is observed in 1997 and worsens in 2003. Although the two incumbents analyzed are public organizations, and their size dropped substantially between these two years, fiscal implications in terms of government bailouts are analyzed.*******************************************************************************************************************Las regulaciones como primaje comunitario, paquetes estandarizados y afiliacion abierta, orientados a reducir los impactos de las fallas en los mercados de seguros, tienen un efecto limitado puesto que abren espacio a la selección sesgada. A partir de 1993, el sistema de seguridad social en salud en Colombia fue reformado hacia un enfoque de mercado con la expectativa de mejorar el desempeño de los monopolios preexistentes exponiéndolos a la competencia de nuevos entrantes. La hipótesis que se maneja en el trabajo es que las fallas de mercado pueden llevar a selección sesgada favoreciendo a los nuevos entrantes. Se analizaron dos encuestas de hogares utilizando el estado de salud auto reportado y la presencia de enfermedad crónica como indicadores prospectivos de riesgo de los afiliados. Se encuentra que hay selección
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