Health Plan Payment in Colombia * *The interpretations and conclusions expressed in this chapter are those of the authors. They do not necessarily represent the views of the Ministry of Health and Social Protection.

Bauhoff, Sebastian; Rodríguez-Bernate, Iván; Göpffarth, Dirk; Guerrero, Ramiro; Galindo-Henriquez, Inés; Nates, Félix

doi:10.1016/b978-0-12-811325-7.00010-5

Cited by 7 publications

(4 citation statements)

References 3 publications

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“…The UPC serves as the insurance premium that comprehensively covers various services and technologies for each health condition, including oral health conditions. This premium is calculated through actuarial methods, considering the frequency and severity of different types of care, with further considerations for age, sex and geographical area 2. Several factors influence the determination of the UPC, including consumer price inflation, the national government budget, demographic changes and the regular updating of services and new technologies.…”

Section: Introductionmentioning

confidence: 99%

“…This premium is calculated through actuarial methods, considering the frequency and severity of different types of care, with further considerations for age, sex and geographical area. 2 Several factors influence the determination of the UPC, including consumer price inflation, the national government budget, demographic changes and the regular updating of services and new technologies. Annually, at the year’s end, the Ministry of Health (MOH) defines the UPC for the following year, drawing on historical information on care as a foundational basis.…”

Section: Introductionmentioning

confidence: 99%

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Unveiling the truth: is COVID-19 reimbursement in Colombia a flawed design? A cost-of-illness analysis for moderate, severe and critical infections

Fernandez-Trujillo,

Sangiovanni,

Castrillon

et al. 2024

BMJ Open Resp Res

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PurposeThis study examines the financial impact of the COVID-19 pandemic on the Colombian Health System, focusing on the adequacy of reimbursement rates for inpatient stays. The study, based on a cost of illness analysis, aims to evaluate the effectiveness of the reimbursement scheme and identify potential economic losses within the health system.Patients and methodsThe study protocol outlines the inclusion criteria for patients >18 years with confirmed COVID-19 infection and moderate to critical disease. Patients hospitalised between June 2020 and June 2021 for at least 24 hours were included. Exclusion criteria involved pregnant patients and those initially hospitalised for non-COVID-19.ResultsThe study included 781 patients contributing to 790 hospitalisations. Demographic and clinical characteristics were analysed, with critical illness being the most prevalent category (61%). The overall mortality rate was 20.3%, primarily observed in critically ill patients. In the general ward for moderate cases, the reimbursement rate saw a substantial increase from US$3237 in 2020 to US$6760 in 2021, surpassing median resource utilisation. However, for severe cases in the intermediate care unit, reimbursement rates decreased, indicating potential insufficiency in covering costs. In the intensive care unit for critical cases, despite improved reimbursement rates, median resource utilisation still exceeds the 2021 rate, suggesting financial insufficiency in reimbursement rates.ConclusionOur study underscores the inadequacies of the previous reimbursement system in addressing the varying resource utilisation and costs associated with COVID-19 inpatient care. Our analysis reveals substantial discrepancies between estimated costs and actual resource utilisation, particularly for severe and critical cases. We advocate for government flexibility in revising reimbursement baskets, supported by pilot studies to assess effectiveness. The use of real-world evidence forms a crucial basis for informed adjustments to reimbursement levels in preparation for future pandemics. This proactive approach ensures alignment between reimbursement policies and the actual costs associated.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Unveiling the truth: is COVID-19 reimbursement in Colombia a flawed design? A cost-of-illness analysis for moderate, severe and critical infections

Fernandez-Trujillo,

Sangiovanni,

Castrillon

et al. 2024

BMJ Open Resp Res

View full text Add to dashboard Cite

show abstract

“…However, several researchers have argued that the implementation of the earmarking policy in some countries was unsuccessful because of several problems [15]- [19]. Some of these problems include rigidity of budget allocations, uneven budget distribution, income distribution function failure, manipulation and compliance issues, the substitution of revenues, tax policy implications, increased tax administration, and compliance cost.…”

Section: Introductionmentioning

confidence: 99%

“…According to the previous research [2], [3], [8], [9], [15]- [20], no researchers have examined the impact of implementing earmarking policies in Indonesia on the health and education sectors directly. Therefore, this study aims to see how the impact of implementing earmarking policies in Indonesia, especially the impact on the education sector and the health sector.…”

Section: Introductionmentioning

confidence: 99%

Earmarking policy: how it affects the Indonesian health and education sector

Fadli,

Sumantri

2023

IJPHS

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This research analyses the implementation of earmarking policies in Indonesia that allocate 20% of expenditure for the education sector and 5% for the health sector by using the difference in difference method in the before and after the pandemic period. This research uses life expectancy at birth, number of maternal deaths, and the budget allocation for health as a representation of the health sector. To represent the education sector, this research uses primary education pupils, the primary school pupils-teacher ratio, and the budget allocation for education. This research also using propensity score matching and chow breakpoint test for robustness checks. The results of this research show the health and education sectors improved during the implementation of earmarking policy.

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Medical labour under neoliberalism: an ethnographic study in Colombia

Ardila-Sierra

Abadía‐Barrero

2020

Int J Public Health

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Objectives In order to increase the knowledge about the impacts of neoliberal market forces on physician's labour, this article's objectives are to analyse how and why the labour of physicians is transformed by neoliberalism, and the implications of these transformations for patient care. Methods Ethnographic investigation is carried out through semi-structured interviews with 20 general practitioners at public and private facilities in Colombia. The interviews were contrasted with national studies of physician's labour since the 1960s. A ''mock'' job search was also simulated. The analysis was guided by Marxian frameworks. The study was approved by a Human Research Ethics Committee, and informed consent was obtained from all participants. Results The overpowering for-profit administration of the Colombian healthcare system imposes productivity mechanisms on physicians as a result of a deregulated labour market characterized by low salaries, reduced and self-funded social security benefits, and job insecurity. Overworked physicians with reduced autonomy become frustrated for not being able to provide the care their patients need according to clinical standards. Conclusions Under neoliberal conditions, medical labour becomes exploitable and directly productive through its formal and real subsumption to Capital. The negative consequences of a progressive loss in physician's autonomy unveil the incompatibility between neoliberal health systems and people's health. Keywords Employment Á Clinical medicine Á Physician-patient relations Á Quality of health care Á Neoliberalism Á Exploitation This article is part of the special issue ''Market-driven forces and Public Health''.

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Health Plan Payment in Colombia * *The interpretations and conclusions expressed in this chapter are those of the authors. They do not necessarily represent the views of the Ministry of Health and Social Protection.

Cited by 7 publications

References 3 publications

Unveiling the truth: is COVID-19 reimbursement in Colombia a flawed design? A cost-of-illness analysis for moderate, severe and critical infections

Unveiling the truth: is COVID-19 reimbursement in Colombia a flawed design? A cost-of-illness analysis for moderate, severe and critical infections

Earmarking policy: how it affects the Indonesian health and education sector

Medical labour under neoliberalism: an ethnographic study in Colombia

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