We develop a condition-based risk adjustment system for healthcare financing in Colombia, where the current age, sex and geographic-based system faces significant challenges.  These shortcomings which include inadequate compensation for high-risk members, necessitate workarounds that compromise efficiency.  Our proposed risk-based financing system provides more accurate and equitable compensation for insurers, eliminating the need for special payments.  This research discusses the existing issues in the current system, details of the development of the new condition-based model, including assessment of its accuracy, as well as contributing to the broader discussion of health reform. 

Short Bio:

Dr. Duncan is Adjunct Professor of Actuarial Statistics at the University of California Santa Barbara and Chief Actuary of Arbital Health.  He has founded or co-founded 5 healthcare analytics companies, including Santa Barbara Actuaries Inc., which merged with Arbital Health in December 2023.  Dr. Duncan holds a graduate degree in economics from Balliol College, Oxford and a PhD in Statistics from Heriot-Watt University, Edinburgh, Scotland. He is a fellow of a number of actuarial societies. He is active in public policy and healthcare reform and served on the board of directors of the Commonwealth of Massachusetts Health Insurance Authority from 2007-2014. He currently serves on the boards of Arbital Health, Clover Insurance (a New Jersey-based Medicare Advantage plan) and the Society of Actuaries.  He is the author of numerous peer-reviewed papers on healthcare outcomes and predictive modeling, and several books. His books include a second edition of “Healthcare Risk Adjustment and Predictive Modeling” (Actex Publications), published in May 2018.