title: Progressive segmented health insurance: Colombian health reform and access to health services.
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.
authors.affiliation: Cendex, Pontificia Universidad Javeriana, Bogotá, Colombia. fruiz@javeriana.edu.co
authors.forename: Fernando
authors.initials: F
authors.lastname: Ruiz
authors.forename: Liliana
authors.initials: L
authors.lastname: Amaya
authors.forename: Stella
authors.initials: S
authors.lastname: Venegas
mesh_terms: D003105:Colombia; D005382:Financing, Personal; D006264:Health Benefit Plans, Employee / Q000331:legislation & jurisprudence; D018166:Health Care Reform / Q000331:legislation & jurisprudence*; D006296:Health Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics* / Q000331:legislation & jurisprudence; D006801:Humans; D016014:Linear Models; D017059:Models, Econometric; D009313:National Health Programs / Q000191:economics / Q000331:legislation & jurisprudence*; D011203:Poverty; D015397:Program Evaluation; D011446:Prospective Studies; D019472:Universal Health Insurance / Q000331:legislation & jurisprudence*