The performance of risk adjustment models in Colombian competitive health insurance market

We introduce new risk groups to a standard capitation formula and evaluate risk selection incentives of insurers. The study uses a unique data set of almost 24 million affiliates to Government's mandatory health insurance system. This data set is very rich in the sense of reporting all claims d...

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Autores:
Riascos Villegas, Alvaro José
Alfonso, Eduardo
Romero, Mauricio
Tipo de recurso:
Work document
Fecha de publicación:
2014
Institución:
Universidad de los Andes
Repositorio:
Séneca: repositorio Uniandes
Idioma:
spa
OAI Identifier:
oai:repositorio.uniandes.edu.co:1992/8506
Acceso en línea:
http://hdl.handle.net/1992/8506
Palabra clave:
Risk adjustment
Diagnostic related groups
Risk selection
Seguridad social - Colombia - Modelos matemáticos
Seguros de salud - Evaluación de riesgos - Colombia
I11, I13, I18
Rights
openAccess
License
http://creativecommons.org/licenses/by-nc-nd/4.0/
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network_name_str Séneca: repositorio Uniandes
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dc.title.none.fl_str_mv The performance of risk adjustment models in Colombian competitive health insurance market
dc.title.alternative.none.fl_str_mv Capacidad explicativa de los modelos de ajuste de riesgo en el sistema de seguridad social en salud en Colombia
title The performance of risk adjustment models in Colombian competitive health insurance market
spellingShingle The performance of risk adjustment models in Colombian competitive health insurance market
Risk adjustment
Diagnostic related groups
Risk selection
Seguridad social - Colombia - Modelos matemáticos
Seguros de salud - Evaluación de riesgos - Colombia
I11, I13, I18
title_short The performance of risk adjustment models in Colombian competitive health insurance market
title_full The performance of risk adjustment models in Colombian competitive health insurance market
title_fullStr The performance of risk adjustment models in Colombian competitive health insurance market
title_full_unstemmed The performance of risk adjustment models in Colombian competitive health insurance market
title_sort The performance of risk adjustment models in Colombian competitive health insurance market
dc.creator.fl_str_mv Riascos Villegas, Alvaro José
Alfonso, Eduardo
Romero, Mauricio
dc.contributor.author.none.fl_str_mv Riascos Villegas, Alvaro José
Alfonso, Eduardo
Romero, Mauricio
dc.subject.keyword.none.fl_str_mv Risk adjustment
Diagnostic related groups
Risk selection
topic Risk adjustment
Diagnostic related groups
Risk selection
Seguridad social - Colombia - Modelos matemáticos
Seguros de salud - Evaluación de riesgos - Colombia
I11, I13, I18
dc.subject.armarc.none.fl_str_mv Seguridad social - Colombia - Modelos matemáticos
Seguros de salud - Evaluación de riesgos - Colombia
dc.subject.jel.none.fl_str_mv I11, I13, I18
description We introduce new risk groups to a standard capitation formula and evaluate risk selection incentives of insurers. The study uses a unique data set of almost 24 million affiliates to Government's mandatory health insurance system. This data set is very rich in the sense of reporting all claims during year 2010, basic demographic variables, initial diagnostic, health services, pharmaceuticals used, etc. It compromises more than 300 million claims. We construct two diagnostic related groups: an adaptation of the 3M algorithm, and a ad hoc diagnostic related group constructed by the authors. Using standard linear capitations formulas we evaluate incentives for cream skimming using several measures. In general, results show a notable improvement in the explanatory power of health expenditures by introducing the ad hoc diagnostic related groups to the standard Colombian risk adjustment formula. With the new risk groups the R2 of the model is 13.53% as opposed to 1.45% of the current formula. Furthermore, for users in the highest expenditure quintile, expected expenditure is 71% of actual expenditure, as opposed to 27% under the current formula. This suggest there is much space for improving the current Colombian capitation formula using information that is currently available.
publishDate 2014
dc.date.issued.none.fl_str_mv 2014
dc.date.accessioned.none.fl_str_mv 2018-09-27T16:53:50Z
dc.date.available.none.fl_str_mv 2018-09-27T16:53:50Z
dc.type.spa.fl_str_mv Documento de trabajo
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dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/1992/8506
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dc.identifier.doi.none.fl_str_mv 10.57784/1992/8506
dc.identifier.instname.spa.fl_str_mv instname:Universidad de los Andes
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url http://hdl.handle.net/1992/8506
dc.language.iso.none.fl_str_mv spa
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dc.relation.ispartofseries.none.fl_str_mv Documentos CEDE No. 33 Agosto de 2014
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dc.format.extent.none.fl_str_mv 82 páginas
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dc.publisher.none.fl_str_mv Universidad de los Andes, Facultad de Economía, CEDE
publisher.none.fl_str_mv Universidad de los Andes, Facultad de Economía, CEDE
institution Universidad de los Andes
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spelling Al consultar y hacer uso de este recurso, está aceptando las condiciones de uso establecidas por los autores.http://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Riascos Villegas, Alvaro José9d5edd1a-2800-42af-b5b7-6cd5baeac192500Alfonso, Eduardod2114050-0ef6-4924-904e-153488c14324500Romero, Mauriciod63643dd-3340-4e4c-a638-03fc8e702a585002018-09-27T16:53:50Z2018-09-27T16:53:50Z20141657-5334http://hdl.handle.net/1992/85061657-719110.57784/1992/8506instname:Universidad de los Andesreponame:Repositorio Institucional Sénecarepourl:https://repositorio.uniandes.edu.co/We introduce new risk groups to a standard capitation formula and evaluate risk selection incentives of insurers. The study uses a unique data set of almost 24 million affiliates to Government's mandatory health insurance system. This data set is very rich in the sense of reporting all claims during year 2010, basic demographic variables, initial diagnostic, health services, pharmaceuticals used, etc. It compromises more than 300 million claims. We construct two diagnostic related groups: an adaptation of the 3M algorithm, and a ad hoc diagnostic related group constructed by the authors. Using standard linear capitations formulas we evaluate incentives for cream skimming using several measures. In general, results show a notable improvement in the explanatory power of health expenditures by introducing the ad hoc diagnostic related groups to the standard Colombian risk adjustment formula. With the new risk groups the R2 of the model is 13.53% as opposed to 1.45% of the current formula. Furthermore, for users in the highest expenditure quintile, expected expenditure is 71% of actual expenditure, as opposed to 27% under the current formula. This suggest there is much space for improving the current Colombian capitation formula using information that is currently available.Introducimos nuevos grupos de riesgo a una fórmula de capitación estándar y evaluamos los incentivos a la selección de riesgos de las aseguradoras. El estudio usa una base de datos única de 24 millones de afiliados al sistema de seguridad social en salud obligatorio de Colombia. La base de datos es muy rica en el sentido de reportar todas las reclamaciones durante el 2010, variables demográficas básicas, código de diagnóstico inicial, servicios de salud, medicamentos, etc. Esta ´ consiste de más de 300 millones de reclamaciones. En este artículo construimos dos grupos relacionados de diagnóstico: una adaptación del algoritmo 3M y unos grupos ad hoc construidos por los autores. En general los resultados muestran una notable mejora, con respecto a la fórmula actual de ajuste de riesgo en Colombia, en el poder explicativo del gasto en salud de utilizar los grupos de diagnóstico de los autores. Con estos nuevos grupos el R2 del modelo es 13,53 % en comparación con el 1,45 % de la fórmula actual. Más aún, para los usuarios del sistema con gastos en el quintil más alto, el gasto esperado es el 71 % del gasto observado, en comparación al 27 % bajo la fórmula actual. Esto sugiere que existe bastante espacio para mejorar la fórmula de capitación actual en Colombia usando información actualmente disponible para el Ministerio de Salud y Protección Social.82 páginasapplication/pdfspaUniversidad de los Andes, Facultad de Economía, CEDEDocumentos CEDE No. 33 Agosto de 2014https://ideas.repec.org/p/col/000089/012062.htmlThe performance of risk adjustment models in Colombian competitive health insurance marketCapacidad explicativa de los modelos de ajuste de riesgo en el sistema de seguridad social en salud en ColombiaDocumento de trabajoinfo:eu-repo/semantics/workingPaperhttp://purl.org/coar/resource_type/c_8042http://purl.org/coar/version/c_970fb48d4fbd8a85Texthttps://purl.org/redcol/resource_type/WPRisk adjustmentDiagnostic related groupsRisk selectionSeguridad social - Colombia - Modelos matemáticosSeguros de salud - Evaluación de riesgos - ColombiaI11, I13, I18Facultad de EconomíaPublicationTHUMBNAILdcede2014-33.pdf.jpgdcede2014-33.pdf.jpgIM Thumbnailimage/jpeg9895https://repositorio.uniandes.edu.co/bitstreams/9422edd0-489a-4948-9037-077a05c2aebe/download407a40cfa65f5afae09d6c5548460f56MD55ORIGINALdcede2014-33.pdfdcede2014-33.pdfapplication/pdf341051https://repositorio.uniandes.edu.co/bitstreams/1e757b74-8ea6-4526-bb2d-ab4c07fe7edc/download32fa2f9dc7e54678dcbc3585f0df1c33MD51TEXTdcede2014-33.pdf.txtdcede2014-33.pdf.txtExtracted texttext/plain42625https://repositorio.uniandes.edu.co/bitstreams/897b76b2-8a51-4455-805c-896fb1c6c1d3/download20a7aeb7cdcd6b6ccf0ffe5db9275c18MD541992/8506oai:repositorio.uniandes.edu.co:1992/85062024-06-04 15:34:47.16http://creativecommons.org/licenses/by-nc-nd/4.0/open.accesshttps://repositorio.uniandes.edu.coRepositorio institucional Sénecaadminrepositorio@uniandes.edu.co