El fortalecimiento de la Superintendencia Nacional de Salud (SUPERSALUD) es prioritario para garantizar el derecho fundamental a la salud.

Espinosa, Óscar; Estrada, Kelly; Franco, Oscar H.; Cepeda-Gil, Magda Cristina; Rodríguez, Paul; Chicaíza, Liliana; Buitrago, Giancarlo; Alvis‐Guzmán, Nelson; Rojas-Botero, Maylen Liseth; Maldonado, Norman; Restrepo, Jairo Humberto; Fernández, Manuel Delgado; Vecino, Andres I.; Mora, Laura; Orozco-Africano, Julio; Vargas, Juan Camilo Niño; García, Mario; Patiño, Pablo Javier; Paternina, Angel; Anaya, Juan Manuel

doi:10.56050/01205498.2188

Cited by 3 publications

(2 citation statements)

References 3 publications

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“…That is why, for any new reform to the GSSSH that may be proposed, it will be essential to consider the future scal impact of the new health care models, as well as strengthening the supervision systems, in order to determine the effects of spending on the population health outcomes. The National Health Superintendency must play a fundamental and active role in monitoring HPE risks, a mission that up to now it has not been able to ful ll completely (32).…”

Section: Discussionmentioning

confidence: 99%

Loss ratio of the Capitation Payment Unit of the Health-Promoting Entities in Colombia between 2017 and 2021: A financial–actuarial approach

Espinosa

Rodríguez

Urdinola³

et al. 2023

Preprint

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Background: Because of a change of government, the Colombian Ministry of Health and Social Protection is in the process of presenting a structural reform for the General System of Social Security in Health (GSSSH), in order to implement a ‘preventive and predictive health model’. However, it will always be relevant to review and analyze the fiscal implications of any proposed public policy program, to protect financial sustainability and to promote the better functioning of the system in question. Methods: To contribute to this topic, we have calculated, using a financial–actuarial approach, the loss ratio for the years 2017 to 2021 for the Capitation Payment Unit (CPU) for all the Health-Promoting Entities (HPE) for both contributory and subsidized schemes. This information, derived from public reports available on the official website of the National Health Superintendency, allows us to estimate the financial burden of the institutions that guarantee access to and provision of health services and technologies in Colombia. Results: The study shows that close to half of the HPEs in Colombia (which represent 11.6 million affiliates) have CPU loss ratios of more than 100% for the year 2021, evidencing insufficient resources for the operation of health insurance. Conclusions: Finally, we propose some policy recommendations regarding the strengthening of informed decision-making to allow the healthy financial sustainability of the Colombian GSSSH.

show abstract

Section: Discussionmentioning

confidence: 99%

Loss ratio of the Capitation Payment Unit of the Health-Promoting Entities in Colombia between 2017 and 2021: A financial–actuarial approach

Espinosa

Rodríguez

Urdinola³

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…That is why, for any new reform to the GSSSH that may be proposed, it will be essential to consider the future fiscal impact of the new health care models, as well as strengthening the supervision systems, in order to determine the effects of spending on the population health outcomes. The National Health Superintendency must play a fundamental and active role in monitoring HPE risks, a mission that up to now it has not been able to fulfill completely [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Loss ratio of the capitation payment unit of the health-promoting entities in Colombia between 2017 and 2021: a financial–actuarial approach

Espinosa,

Rodríguez,

Urdinola

et al. 2023

Cost Eff Resour Alloc

Self Cite

View full text Add to dashboard Cite

Background Because of a change of government, the Colombian Ministry of Health and Social Protection is in the process of presenting a structural reform for the General System of Social Security in Health (GSSSH), in order to implement a ‘preventive and predictive health model’. However, it will always be relevant to review and analyze the fiscal implications of any proposed public policy program, to protect financial sustainability and to promote the better functioning of the system in question. Methods To contribute to this topic, we have calculated, using a financial–actuarial approach, the loss ratio for the years 2017 to 2021 for the Capitation Payment Unit (CPU) for all the Health-Promoting Entities (HPE) for both contributory and subsidized schemes. This information, derived from public reports available on the official website of the National Health Superintendency, allows us to estimate the financial burden of the institutions that guarantee access to and provision of health services and technologies in Colombia. Results The study shows that close to half of the HPEs in Colombia (which represent 11.6 million affiliates) have CPU loss ratios of more than 100% for the year 2021, evidencing insufficient resources for the operation of health insurance. Conclusions Finally, we propose some policy recommendations regarding the strengthening of informed decision-making to allow the healthy financial sustainability of the Colombian GSSSH.

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Proposal of a Knowledge Management Model for Complex Systems: Case of the Supervision and Control Subsystem of the Colombian Health System

Rodríguez-Páez,

Cabrera-Moya,

Herrera-Cuartas

2024

JMAHP

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Background: Considering regulatory, supervision, and control health policy, an innovative knowledge management model is proposed for the Colombian health system, which is recognized as a complex system. Methods: A model is constructed through a comparative analysis of various theoretical and conceptual frameworks, and an original methodology is proposed based on an analysis of the macroprocesses of the Supervision and Control System (SSC) of the Colombian General Social Security System in Health (SGSSS). After formulating hypotheses and conceptual references, information errors are determined within the different macroprocesses of the SGSSS, including those of governance and the SSC. Results: The risks of generating duplicate, wrong, hidden, or non-existent information arise when the associated regulations need more specificity to be applied in all cases, thus leading to the risk of different interpretations by some actors. In this way, it is possible to hinder the generation of unified information, as there is no clarity as to who is responsible for the generation or creation of certain data. Conclusions: The proposed model is characterized by its flexibility and adaptability, integrating several processes that can be executed simultaneously or cyclically (depending on the system’s needs) and allowing for the generation and feedback of knowledge at different stages, with some processes simultaneously executed to complement each other.

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El fortalecimiento de la Superintendencia Nacional de Salud (SUPERSALUD) es prioritario para garantizar el derecho fundamental a la salud.

Cited by 3 publications

References 3 publications

Loss ratio of the Capitation Payment Unit of the Health-Promoting Entities in Colombia between 2017 and 2021: A financial–actuarial approach

Loss ratio of the Capitation Payment Unit of the Health-Promoting Entities in Colombia between 2017 and 2021: A financial–actuarial approach

Loss ratio of the capitation payment unit of the health-promoting entities in Colombia between 2017 and 2021: a financial–actuarial approach

Proposal of a Knowledge Management Model for Complex Systems: Case of the Supervision and Control Subsystem of the Colombian Health System

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