The impact of periodic updates to health benefits plan: access gains without cost savings?

Oscar Espinosa (), Paul Rodríguez-Lesmes (), Jhonathan Rodríguez (), Diego Ávila (), Sergio Basto (), Giancarlo Romano (), Lorena Mesa () and Hernán Enríquez ()
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Oscar Espinosa: Instituto de Evaluación Tecnológica en Salud (IETS)
Paul Rodríguez-Lesmes: Instituto de Evaluación Tecnológica en Salud (IETS)
Jhonathan Rodríguez: Instituto de Evaluación Tecnológica en Salud (IETS)
Diego Ávila: Instituto de Evaluación Tecnológica en Salud (IETS)
Sergio Basto: Instituto de Evaluación Tecnológica en Salud (IETS)
Giancarlo Romano: Instituto de Evaluación Tecnológica en Salud (IETS)
Lorena Mesa: Instituto de Evaluación Tecnológica en Salud (IETS)
Hernán Enríquez: Instituto de Evaluación Tecnológica en Salud (IETS)

International Journal of Health Economics and Management, 2025, vol. 25, issue 3, No 2, 317-336

Abstract: Abstract Expanding explicit Health Benefit Plans (HBP) is a key strategy for achieving universal health coverage while maintaining financial sustainability. However, little is known about the broader effects of periodic updates to these plans on healthcare utilization, expenditures, and market dynamics. This study examines the impact of including new health technologies in Colombia’s HBP covered by the Capitation Payment Unit (CPU) between 2012 and 2019, using administrative data and a difference-in-differences approach with multiple periods. Our results indicate that inclusion in the HBP-CPU led to a substantial increase in utilization and access, particularly in remote areas, but had mixed effects on expenditures. While the number of unique users and prescription frequency rose significantly, the cost per user remained stable for procedures but increased for medications, likely due to higher demand and market structures. These findings suggest that although periodic HBP updates enhance access and effective coverage, they do not necessarily generate cost savings. Strengthening health technology assessment processes, integrating price regulation policies, and implementing cost-containment mechanisms are essential for ensuring the financial sustainability of health systems that regularly update benefit plans.

Keywords: Health benefit plans; Universal health coverage; Health technology assessment; Health expenditures; Cost-containment policies; Pharmaceutical markets; Colombia; Health policy (search for similar items in EconPapers)
JEL-codes: C23 H51 I13 I18 (search for similar items in EconPapers)
Date: 2025
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DOI: 10.1007/s10754-025-09394-7

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