Expanding Health Coverage to Reduce Direct and Indirect Costs: A Territorial Equity Approach in Colombia
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.
1UNIVERSIDAD DE CARTAGENA, Cartagena, Colombia, 2Universidad de Cartagena - ALZAK Foundation, Cartagena, Colombia.
OBJECTIVES: To assess how expanding health coverage in Colombia—through both contributory and subsidized regimes—can reduce direct and indirect healthcare costs, especially in underserved rural and remote areas. The study evaluates how territorial equity, insurance mechanisms, and service availability interact to improve population health and financial efficiency.
METHODS: A mixed-methods approach was applied, combining spatial data analysis, review of national health expenditure reports (2017-2023), and interviews with 18 territorial health managers. Coverage expansion scenarios were modeled using epidemiological and service utilization data from three Caribbean departments. Direct cost savings (hospitalizations, emergency care, referrals) and indirect costs (lost productivity, out-of-pocket payments, delayed diagnosis) were compared across areas with low and high coverage indices.
RESULTS: Municipalities with lower coverage (<70%) experienced higher average direct medical costs per capita (COP $1.3 million) than those with higher coverage (>90%), where costs were reduced by up to 42%. Indirect costs related to absenteeism, transportation, and catastrophic health spending were also 2.1 times higher in low-coverage territories. Strengthening coverage—particularly in rural and informal populations—led to earlier detection of chronic conditions, reduced use of high-cost emergency care, and improved treatment adherence. The study also found that integrated service networks and mobile health units were critical to expanding access in dispersed regions.
CONCLUSIONS: Expanding health coverage is not only a matter of social justice but also a strategic tool to reduce long-term healthcare costs. Investing in equitable access through strengthened insurance schemes and service availability in remote areas leads to earlier interventions, fewer complications, and more efficient resource use. Policy reforms that prioritize territorial equity in coverage can generate measurable clinical and economic benefits across Colombia’s fragmented health landscape.
METHODS: A mixed-methods approach was applied, combining spatial data analysis, review of national health expenditure reports (2017-2023), and interviews with 18 territorial health managers. Coverage expansion scenarios were modeled using epidemiological and service utilization data from three Caribbean departments. Direct cost savings (hospitalizations, emergency care, referrals) and indirect costs (lost productivity, out-of-pocket payments, delayed diagnosis) were compared across areas with low and high coverage indices.
RESULTS: Municipalities with lower coverage (<70%) experienced higher average direct medical costs per capita (COP $1.3 million) than those with higher coverage (>90%), where costs were reduced by up to 42%. Indirect costs related to absenteeism, transportation, and catastrophic health spending were also 2.1 times higher in low-coverage territories. Strengthening coverage—particularly in rural and informal populations—led to earlier detection of chronic conditions, reduced use of high-cost emergency care, and improved treatment adherence. The study also found that integrated service networks and mobile health units were critical to expanding access in dispersed regions.
CONCLUSIONS: Expanding health coverage is not only a matter of social justice but also a strategic tool to reduce long-term healthcare costs. Investing in equitable access through strengthened insurance schemes and service availability in remote areas leads to earlier interventions, fewer complications, and more efficient resource use. Policy reforms that prioritize territorial equity in coverage can generate measurable clinical and economic benefits across Colombia’s fragmented health landscape.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HPR85
Topic
Economic Evaluation, Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Coverage with Evidence Development & Adaptive Pathways, Insurance Systems & National Health Care
Disease
No Additional Disease & Conditions/Specialized Treatment Areas