- PSTAT seminar
Title: Closing the Financial Gap in Colombia’s Health Sector: A Proposed New methodology for calculating the UPC
Speaker: Ian Duncan, PhD FSA MAAA and Juan Diego Mejia Becerra, MS
Abstract: Colombia has a publicly funded health insurance program that aims to have universal coverage; the population is covered by two regimes: non-contributory and contributory. Reimbursement is provided by the Colombian Treasury through insurers (EPSs). Reimbursement has traditionally followed insured members based on their age, sex and territory. The Colombian ministry of health asked our company (Santa Barbara Actuaries Inc.) to design a new reimbursement system that would more accurately project budget needs as well as reimbursement of individual member needs. The solution chosen was a risk adjustment system, an actuarial tool that enables equitable distribution of funds between risk-bearing entities, matching reimbursement to need for resources. Risk-adjustment systems are used by payers around the world to achieve payment accuracy; while there are differences between payment systems the fundamental principles are the same internationally. We developed risk adjustment models for Colombia using regression, applied to clinical risk groups developed specifically for the Colombian system. We evaluated the proposed model against a number of alternative models, including the current system. We also proposed a number of system changes to better manage insurer risk and avoid some of the known draw-backs of risk adjustment systems.
Bio: Ian Duncan PhD FSA FIA FCIA FCA CSPA MAAA is Adjunct Professor of Actuarial Statistics at the University of California, Santa Barbara and President of Santa Barbara Actuaries Inc. He has published over 70 peer-reviewed studies of care management programs and associated predictive models and is author of the widely referenced book: Healthcare Risk Adjustment and Predictive Modelling (2nd ed. 2018). Ian has been a member of numerous Boards of Directors including the Massachusetts Health Insurance Connector Authority. He holds a graduate degree in economics from Balliol College, Oxford and a PhD in Actuarial Statistics from Heriot-Watt University, Edinburgh.
Bio: Juan Diego Mejia Becerra MS is a PhD candidate in the Dept. of Statistics & Applied Probability at the University of California Santa Barbara and an intern at Santa Barbara Actuaries Inc. He holds a masters degree from National University, Colombia.