Cream-Skimming And Risk Adjustment in Colombian Health Insurance System:: The Public Insurer Case
This paper analyses the particular case of the bankruptcy of the biggest public insurer in the Colombian Health insurance system (contributory regime) in order to identify some selection atterns within such an insurance market. Using both cross-section and built-in panel data from DANE Quality of Life Survey in two waves (1997 and 2003) and applying an empirical approach based on binary choice models, the paper tries to solve two main questions. The first one is whether exists empirical evidence about advantageous selection in the contributory scheme of Colombian health insurance system. Secondly, I tried to establish whether cream-skimming (if existed) had real influence in the bankruptcy of the Colombian public insurer, which also would imply failures in the risk-adjustment formula. In the final section the principles of a good riskadjustment system suitable for the local scenario are drafted. The results show a strong evidence of dynamic selection from 1997 to 2003, which could take place by favoring both favorable age load" and good socio economic status (income, education, work type and location) for private insurers. No evidence of selection based on household analysis was found, which reinforces the idea of an individual appraisal before enrollment. This situation affected the financial performance of the public insurance, but by no means was the definitive factor of the bankruptcy. On the other hand, the risk adjustment formula used in the Colombian system presents some theoretical flaws and stillis established upon information from fifteen years ago. However, without updated information on morbidity and health care usage (not available) is not possible to measure the quantitative extent of such failures in an accurate manner"
|Date of creation:||30 Oct 2007|
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- Jairo Restrepo & Andrés Zambrano & Mauricio Velez & Manuel Ramirez, 2007. "Health insurance as a strategy for access: streamlined facts of the colombian health care reform," DOCUMENTOS DE TRABAJO 002783, UNIVERSIDAD DEL ROSARIO.
- Titelman Kardonsky, Daniel & Uthoff, Andras, 2003. "The role of insurance in social protection," Revista CEPAL, Naciones Unidas Comisión Económica para América Latina y el Caribe (CEPAL), December.
- Erik Schokkaert & Carine Van de Voorde, 2000. "Risk adjustment and the fear of markets: The case of Belgium," Health Care Management Science, Springer, vol. 3(2), pages 121-130, February.
- Van de ven, Wynand P.M.M. & Ellis, Randall P., 2000. "Risk adjustment in competitive health plan markets," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 14, pages 755-845 Elsevier.
- Shen, Yujing & Ellis, Randall P., 2002.
"Cost-minimizing risk adjustment,"
Journal of Health Economics,
Elsevier, vol. 21(3), pages 515-530, May.
- Knaus, Thomas & Nuscheler, Robert, 2002.
"Incomplete risk adjustment and adverse selection in the German public health insurance system
[Unvollständiger Risikostrukturausgleich und Adverse Selektion in der Gesetzlichen Krankenversicherung ," Discussion Papers, Research Unit: Market Processes and Governance FS IV 02-27, Social Science Research Center Berlin (WZB).
- Londono, Juan-Luis & Frenk, Julio, 1997. "Structured pluralism: towards an innovative model for health system reform in Latin America," Health Policy, Elsevier, vol. 41(1), pages 1-36, July.
- Newhouse, Joseph P., 1984. "Cream skimming, asymmetric information, and a competitive insurance market," Journal of Health Economics, Elsevier, vol. 3(1), pages 97-100, April.
- Ramón Abel Castaño & Andrés Zambrano, 2005.
"Biased selection within the social health insurance market in Colombia,"
BORRADORES DE INVESTIGACIÓN
002063, UNIVERSIDAD DEL ROSARIO.
- Castano, Ramon & Zambrano, Andres, 2006. "Biased selection within the social health insurance market in Colombia," Health Policy, Elsevier, vol. 79(2-3), pages 313-324, December.
- Adriana Lleras-Muney, 2005. "The Relationship Between Education and Adult Mortality in the United States," Review of Economic Studies, Oxford University Press, vol. 72(1), pages 189-221.
- Altman, Daniel & Cutler, David M & Zeckhauser, Richard J, 1998. "Adverse Selection and Adverse Retention," American Economic Review, American Economic Association, vol. 88(2), pages 122-126, May.
- Joseph P. Newhouse, 1996. "Reimbursing Health Plans and Health Providers: Efficiency in Production versus Selection," Journal of Economic Literature, American Economic Association, vol. 34(3), pages 1236-1263, September.
- Amir Shmueli, 2001. "The effect of health on acute care supplemental insurance ownership: an empirical analysis," Health Economics, John Wiley & Sons, Ltd., vol. 10(4), pages 341-350.
- Karen Eggleston & Anupa Bir, 2009.
"Measuring Selection Incentives in Managed Care: Evidence From the Massachusetts State Employee Insurance Program,"
Journal of Risk & Insurance,
The American Risk and Insurance Association, vol. 76(1), pages 159-175.
- Anupa Bir & Karen Eggleston, 2006. "Measuring Selection Incentives in Managed Care: Evidence from the Massachusetts State Employee Insurance Program," Discussion Papers Series, Department of Economics, Tufts University 0605, Department of Economics, Tufts University.
- David M. Cutler & Sarah J. Reber, 1998. "Paying for Health Insurance: The Trade-Off between Competition and Adverse Selection," The Quarterly Journal of Economics, Oxford University Press, vol. 113(2), pages 433-466.
- David M. Cutler, 1994. "A Guide to Health Care Reform," Journal of Economic Perspectives, American Economic Association, vol. 8(3), pages 13-29, Summer.
- James P. Smith, 1999. "Healthy Bodies and Thick Wallets: The Dual Relation between Health and Economic Status," Journal of Economic Perspectives, American Economic Association, vol. 13(2), pages 145-166, Spring.
- Peter Zweifel, 2005. "The Purpose and Limits of Social Health Insurance," SOI - Working Papers 0509, Socioeconomic Institute - University of Zurich, revised Sep 2005.
- Beck, Konstantin & Spycher, Stefan & Holly, Alberto & Gardiol, Lucien, 2003. "Risk adjustment in Switzerland," Health Policy, Elsevier, vol. 65(1), pages 63-74, July.
- Pauly, Mark V., 1984. "Is cream-skimming a problem for the competitive medical market?," Journal of Health Economics, Elsevier, vol. 3(1), pages 87-95, April.
- Barros, Pedro Pita, 2003. "Cream-skimming, incentives for efficiency and payment system," Journal of Health Economics, Elsevier, vol. 22(3), pages 419-443, May.
- repec:idb:brikps:publication-detail,7101.html?id=25948 is not listed on IDEAS
- Jack, William, 2000. "Health insurance reform in four Latin American countries : theory and practice," Policy Research Working Paper Series 2492, The World Bank.
- Newhouse, Joseph P., 1982. "Is competition the answer?," Journal of Health Economics, Elsevier, vol. 1(1), pages 109-116, May.
- Cutler, David M. & Zeckhauser, Richard J., 2000.
"The anatomy of health insurance,"
Handbook of Health Economics,
in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 11, pages 563-643
- Ellis, Randall P., 1998. "Creaming, skimping and dumping: provider competition on the intensive and extensive margins1," Journal of Health Economics, Elsevier, vol. 17(5), pages 537-555, October.
- Michael Rothschild & Joseph Stiglitz, 1976. "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," The Quarterly Journal of Economics, Oxford University Press, vol. 90(4), pages 629-649.
- Belli, Paolo, 2001. "How adverse selection affects the health insurance market," Policy Research Working Paper Series 2574, The World Bank.
- Thomas G. McGuire & Jacob Glazer, 2000. "Optimal Risk Adjustment in Markets with Adverse Selection: An Application to Managed Care," American Economic Review, American Economic Association, vol. 90(4), pages 1055-1071, September.
- William Jack(Georgetown University), 2004. "Optimal risk adjustment in a model with adverse selection and spatial competition," Working Papers gueconwpa~04-04-15, Georgetown University, Department of Economics.
- Katherine Swartz, 2003. "Reinsuring Risk to Increase Access to Health Insurance," American Economic Review, American Economic Association, vol. 93(2), pages 283-287, May.
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