Abstracts Health Sciences

Adjustment to the calculation risk model of the Capitation Payment Unit considering risk groups in the Health Promotion Entity of the contributory regime

by Jader Yate Ramírez

Adjustment to the calculation risk model of the Capitation Payment Unit considering risk groups in the Health Promotion Entity of the contributory regime The general objective of this study is to improve the predictive capacity of a risk adjustment methodology that allows a better calculation and update of the Unit of Payment by Capitation -UPC-. The resources of health insurance in Colombia -Minsalud-, are assigned mainly considering the components of age, sex and geographical areas, variables with demographic characteristics. The methodology consisted of estimating the current Minsalud model and proposing a model considering health conditions based on the work of (Riascos et al. 2017) and (Lancheros, 2019), for 3 Health Promoting Entities of the contributory regime with more than 12 million of affiliates, for each of the models the UPC was determined in the different risk groups for the year 2021. The model that presented the best performance corresponded to the model that considers health conditions and proposes the 22 risk groups, having a lower mean square error (1,192 compared to 1,216 in the Minsalud model) and lower mean absolute error (2,391 and 2,481 respectively) a greater explanation of the variance. The proposed model demonstrates that including health status variables (CIE10 diagnosis) in the calculation of the UPC for the contributory regime increases the capacity of each insurer to cover the total number of services and technologies included in the Benefits Plan. of Health -PBS-. On the contrary, the allocation of resources under the model currently adopted by the Ministry of Health is not sufficient to meet the health needs of the population of the selected Health Promoting Entities.