Presentation (CTI)

OBJECTIVES: This research aims to propose strategic adaptations to health insurance models in Colombia to address equity challenges across urban, rural, and dispersed rural areas. The goal is to identify flexible models that accommodate demographic and geographic differences while ensuring timely access and financial protection.
METHODS: Comparative policy analysis was performed on health service delivery data from five Colombian departments. Socio-territorial variables (population density, access times, referral patterns) were cross-analyzed with current service delivery models, payment methods, and access outcomes. A needs-based risk stratification tool was also applied.
RESULTS: Urban centers with high population density presented elevated demand concentration and delayed care during high-volume events, despite better infrastructure. Conversely, rural and dispersed rural zones showed low service availability, fragmented access, and unmet needs due to the lack of adaptive contracting and low provider incentives. Implementing modular protocols, differentiated capitation models, and integrated mobile health strategies proved successful in pilot regions.
CONCLUSIONS: A one-size-fits-all insurance model is inadequate for Colombia’s diverse geography. Strategic differentiation by territory—combined with tailored risk-adjusted contracting and mobile service innovation—is key to advancing equity and sustainability. Territorial flexibility must be institutionalized within EPS and IPS frameworks to meet population health needs across regions.