Financial Inefficiency and Systemic Risk in Colombian Health Insurers: A Cost and Technology Utilization Analysis

Author(s)

JUAN C. FERNANDEZ MERCADO, MBA, MSc, PhD, MD1, Nelson Alvis-Guzman, MPH, PhD, MD2.
1UNIVERSIDAD DE CARTAGENA, Cartagena, Colombia, 2Universidad de Cartagena - ALZAK Foundation, Cartagena, Colombia.
OBJECTIVES: This study explores the relationship between systemic underfunding in Colombia’s health system and the increasing utilization of high-cost technologies. The focus is on the deterioration of financial sustainability among insurers (EPS) and providers (IPS) due to weak investment in primary and secondary risk management strategies.
METHODS: A cross-sectional analysis was conducted using financial reports and service utilization data from selected Colombian EPS and IPS between 2022 and 2024. Metrics included: per capita health spending trends, primary care investment ratio, and technology-related cost escalation. Interviews with strategic health directors were also conducted to triangulate findings.
RESULTS: The data revealed a significant shift in expenditure patterns. While technology-related interventions increased by 37%, primary care risk management spending remained flat. The ratio of spending on high-cost events (e.g., ICU admissions, amputations, biologic therapies) rose disproportionately, contributing to an average 18% annual deficit in selected EPS. Moreover, delays in early detection programs and low adherence to care pathways in chronic conditions exacerbated the need for expensive, reactive care.
CONCLUSIONS: Colombia’s health system shows an unsustainable trajectory where cost-intensive technologies are prioritized over proactive, lower-cost risk mitigation. Strategic redirection of financial flows toward early management and prevention is crucial. Without timely correction, the structural imbalance could further collapse regional insurer-provider networks.

Conference/Value in Health Info

2025-11, ISPOR Europe 2025, Glasgow, Scotland

Value in Health, Volume 28, Issue S2

Code

EE468

Topic

Economic Evaluation, Health Service Delivery & Process of Care, Organizational Practices

Topic Subcategory

Budget Impact Analysis, Cost/Cost of Illness/Resource Use Studies

Disease

No Additional Disease & Conditions/Specialized Treatment Areas

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