Collateral Impact of Government-Intervened Health Insurers on the Colombian Health System: A Causal Analysis of Financial, Health, and Perception Outcomes (2023-2025)
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 whether the poor performance of government-intervened health insurers (EPS) in Colombia has indirectly contributed to a systemic deterioration in healthcare outcomes, financial sustainability, and user perception across the entire system, including non-intervened EPS. The study explores potential causal spillover effects resulting from structural imbalances exacerbated by the interventions.
METHODS: A mixed-methods approach was employed combining quantitative financial data (2023-2024), health service indicators (hospitalizations, ER visits, medication access), and national satisfaction/perception surveys (MinSalud, Supersalud) for both intervened and non-intervened EPS. We conducted a difference-in-differences analysis and structural equation modeling (SEM) to explore indirect causal relationships. Externalities such as delayed budget allocations, medication stock-outs, and regional healthcare network saturation were modeled as mediating variables.
RESULTS: EPS under intervention (Nueva EPS, Sanitas, Coosalud, Famisanar) presented a cumulative deficit exceeding COP $1.2 trillion by Q1 2025 and a surge in PQRS and tutela filings (+101% and +34% respectively). However, non-intervened EPS also experienced decreased satisfaction scores (−7.2%), longer appointment delays (+18%), and increased administrative burden attributed to overflow and cross-utilization effects from intervened EPS. SEM revealed significant exogenous influence (β = 0.61; p < 0.05) of the operational deterioration in intervened EPS on the health access indicators of non-intervened ones. Regional network strain and medication supply chain collapse were the most critical mediators.
CONCLUSIONS: The government intervention of major EPS in Colombia has not been a contained corrective measure but rather a system-wide shock that has indirectly affected the operational and financial performance of non-intervened EPS. These findings underscore the need for coordinated system-level reforms, beyond case-by-case EPS interventions, including supply chain stabilization, regional load balancing, and risk-based resource distribution to prevent systemic collapse.
METHODS: A mixed-methods approach was employed combining quantitative financial data (2023-2024), health service indicators (hospitalizations, ER visits, medication access), and national satisfaction/perception surveys (MinSalud, Supersalud) for both intervened and non-intervened EPS. We conducted a difference-in-differences analysis and structural equation modeling (SEM) to explore indirect causal relationships. Externalities such as delayed budget allocations, medication stock-outs, and regional healthcare network saturation were modeled as mediating variables.
RESULTS: EPS under intervention (Nueva EPS, Sanitas, Coosalud, Famisanar) presented a cumulative deficit exceeding COP $1.2 trillion by Q1 2025 and a surge in PQRS and tutela filings (+101% and +34% respectively). However, non-intervened EPS also experienced decreased satisfaction scores (−7.2%), longer appointment delays (+18%), and increased administrative burden attributed to overflow and cross-utilization effects from intervened EPS. SEM revealed significant exogenous influence (β = 0.61; p < 0.05) of the operational deterioration in intervened EPS on the health access indicators of non-intervened ones. Regional network strain and medication supply chain collapse were the most critical mediators.
CONCLUSIONS: The government intervention of major EPS in Colombia has not been a contained corrective measure but rather a system-wide shock that has indirectly affected the operational and financial performance of non-intervened EPS. These findings underscore the need for coordinated system-level reforms, beyond case-by-case EPS interventions, including supply chain stabilization, regional load balancing, and risk-based resource distribution to prevent systemic collapse.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
PCR46
Topic
Economic Evaluation, Health Policy & Regulatory, Patient-Centered Research
Topic Subcategory
Health State Utilities
Disease
No Additional Disease & Conditions/Specialized Treatment Areas