A Proposed Condition-Based Risk Adjustment System for the Colombian Health Insurance Program

Ian Duncan, Juan Diego Mejia Becerra and Tamim Ahmed

North American Actuarial Journal, 2025, vol. 29, issue 3, 592-606

Abstract: This article explores the development of 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, including inadequate compensation for high-risk members, necessitate workarounds that compromise efficiency. We propose a condition-based system that provides more accurate and equitable compensation, eliminating the need for special payments. This research discusses the existing issues in the current system, details the construction process of the condition-based risk adjustment system, and assesses its accuracy. This study not only offers an alternative to the current compensation system but also contributes to the broader discourse on health insurance reform.

Date: 2025
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DOI: 10.1080/10920277.2024.2387116

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