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


  • Fernando Ruiz

    (Cendex, Pontificia Universidad Javeriana, Bogotá, Colombia)

  • Liliana Amaya

    (Cendex, Pontificia Universidad Javeriana, Bogotá, Colombia)

  • Stella Venegas

    (Cendex, Pontificia Universidad Javeriana, Bogotá, Colombia)


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.
  • Handle: RePEc:wly:hlthec:v:16:y:2007:i:1:p:3-18
    DOI: 10.1002/hec.1147

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    References listed on IDEAS

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    8. 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.
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