Ajuste por riesgo para el cálculo de la UPC en Colombia: ajuste desde las variables de estado de salud para las aseguradoras colombianas

Abstract

Risk adjustment is a fundamental element in the design of public health policies. Currently, the Ministry of Health and Social Protection of Colombia estimates the values of the capitation payment unit through a risk adjustment model, which only takes into account variables such as geographical location, age and sex. The objective of this document is to demonstrate that a risk adjustment model that takes into account health status variables can more efficiently allocate resources to the insurers of the contributory regime through the capitation payment unit. Through a review of the current calculation methodology and the comparison with a proposed model using risk groups that indicate the health status of an individual, using various indicators of accuracy, prediction and a sensitivity analysis on a sample of a data base used to allocate the capitation payment unit resources, this document estimates, in the context of an insurer of the tax system, the values that improve the allocation of resources for each risk group.

The values estimated by the proposed model have a better performance in the selected indicators, and are stable to variations, as evidenced by sensitivity analyzes. They also guarantee that the expense is less than the income that would be received with the implementation of the proposed risk adjustment model.