Evaluating Colombia's Health Insurers Efficiency in Lung Cancer Management: A Data Envelopment Analysis

OBJECTIVES:

This study measures and analyzes Colombian health insurer’s efficiency in lung cancer management in 2020. These results are compared against therapeutic goals’ accomplishment to provide a picture between insurer’s efficiency and effectiveness.

METHODS:

Analysis was performed using Colombian lung cancer insured population between January 2, 2020 and January 1, 2021 administrative records reported to the High Cost Disease Fund of Colombia. Efficiency scores of lung cancer management where obtained through Data Envelopment Analysis, for third payer and state insurers. Inputs included total enrolled population and wait times of diagnosis and treatment; while outputs included lethality, mortality and health risk management indicators. Efficient results of selected health risk management indicators where compared to suggested levels in Colombia’s lung cancer health risk indicators consensus to assess effectiveness in therapeutic goals accomplishment.

RESULTS:

From 37 third payer or state regimes insurers, 24 (65%) were found to be efficient. From the non-efficient 9 were from the state regime and 4 from the third payer. The indicators with lowest accomplishment levels were diagnosis and treatment wait times, proportion of lung cancer population with systemic therapy or early diagnosis, mortality and lethality. There was no insurer which resulted efficient and fulfilled all of the therapeutic accomplishment goals.

CONCLUSIONS:

Although 65% of Colombia’s third payer or state regime insurers were efficient in 2020, none fulfilled high accomplishment of therapeutic goals. Differences between efficiency scores among insurers were not explained because of a higher proportion of difficult to manage lung cancer enrollees.