Risk Protection, Service Use, and Health Outcomes under Colombia's Health Insurance Program for the Poor

Abstract

Unexpected medical care spending imposes considerable financial risk on developing country households. Based on managed care models of health insurance in wealthy countries, Colombia’s Régimen Subsidiado is a publicly financed insurance program targeted to the poor, aiming both to provide risk protection and to promote allocative efficiency in the use of medical care. Using a “fuzzy” regression discontinuity design, we find that the program has shielded the poor from some financial risk while increasing the use of traditionally under-utilized preventive services – with measurable health gains.

The effects of access to health insurance: Evidence from a regression discontinuity design in Peru

“…Miller et al (2013), in contrast, find for Colombia that insurance lowers both mean inpatient medical spending and its variability. Likewise, Limwattananon et al (2015) find that health insurance coverage leads to a decrease in out-of-pocket spending in Thailand.…”

“…This could be an indication of moral hazard, in the sense that patients invest less in their health in case they are covered by health insurance. It is interesting to contrast these results to the ones by Miller et al (2013) for Colombia, where the system provides larger incentives to invest in preventive care, as already discussed in Section 1. And indeed, Miller et al (2013) find stronger positive effects on preventive care.…”

“…It is the mean absolute deviation of health expenditures, calculated separately by insurance status, and similar to the one used by Miller et al (2013). Health insurance has no significant effect on it.…”

Health Insecurity and Social Protection: Pathways, Gaps, and Their Implications on Health Outcomes and Poverty

“…1,2,10,14,17 It is, therefore, crucial that discussions around social protection in healthcare shift from the current focus on single instruments to broader integrated interventions or a mix of interventions, capable of addressing these diverse objectives. [36][37][38][39] Integrated social protection programs 39,40 play a central role in mitigating against the impact of health insecurity, poverty, and vulnerability due to healthcare expenditure. 17,35,38 The combined effects of worsening health insecurity, poverty, and vulnerability as a result of out-of-pocket healthcare expenditure and a weak social protection response set the scene, not only for severe poverty and inequality in the medium and long term, but also for stifled economic development.…”

“…[36][37][38][39] Integrated social protection programs 39,40 play a central role in mitigating against the impact of health insecurity, poverty, and vulnerability due to healthcare expenditure. 17,35,38 The combined effects of worsening health insecurity, poverty, and vulnerability as a result of out-of-pocket healthcare expenditure and a weak social protection response set the scene, not only for severe poverty and inequality in the medium and long term, but also for stifled economic development. 12,13,36 Important to all policy-makers in the health sector is an understanding of what determines the success of SPH in reducing health insecurity, poverty, vulnerability, inequality, and promoting productivity.…”