Risk Protection, Service Use, and Health Outcomes under Colombia's Health Insurance Program for the Poor

Abstract

Unexpected medical care spending imposes considerable financial risk on developing country households. Based on managed care models of health insurance in wealthy countries, Colombia's Régimen Subsidiado is a publicly financed insurance program targeted to the poor, aiming both to provide risk protection and to promote allocative efficiency in the use of medical care. Using a "fuzzy" regression discontinuity design, we find that the program has shielded the poor from some financial risk while increasing the use of traditionally under-utilized preventive services - with measurable health gains.

Figure 1. Subsidized Regime Enrollment and ‘Uninsurance’ across SISBEN Eligibility Thresholds

Notes: Source of Figure A is ECV 2003 and of Figure B is DHS 2005

Figure 2

Subsidized Regime Enrollment and ‘Uninsurance’ across SISBEN Eligibility Thresholds by Region

Figure 3. Individual Inpatient Medical Spending (Among those within Two Points of County-Specific Eligibility Thresholds)

Notes: Source ECV 2003

Figure 4. Individual Outpatient Medical Spending (Among those within Two Points of County-Specific Eligibility Thresholds)

Notes: Source ECV 2003