OBJECTIVES:

This study evaluates third payer and state regimes health insurer’s efficiency in HIV health risk management in Colombia in 2020. A discussion between efficiency and effectiveness is assessed through comparison of specific health indicators levels in efficient insurers against suggested levels in Colombia’s HIV health risk indicators consensus.

METHODS:

Administrative records of HIV population provided by insurers to the High Cost Disease Fund of Colombia between February 1, 2020 and January 31, 2021 were used to build HIV health risk management indicators and enrolled population to each insurer from third payer and state regimes. Efficiency scores were obtained using Data Envelopment Analysis and efficient insurer’s indicators were compared to Colombia’s HIV health risk indicators consensus to assess effectiveness in therapeutic goals accomplishment. Inputs included treatment wait times and enrolled population, while outputs included health risk indicators, mortality and lethality.

RESULTS:

From 38 third payer and state regimes insurers, 30 (79%) were found to be efficient. From the non-efficient insurers 5 belong to the state regime and 3 to the third payer. The indicators with the lowest accomplishment were HIV screening in pregnant women, genotypic resistance testing, proportion of HIV population with undetectable viral loads and HIV early detection. Even among efficient insurers, none fulfilled all of the therapeutic accomplishment goals.

CONCLUSIONS:

Though almost 80% of Colombia’s third payer and state regimes insurers were found as efficient, none fulfills all HIV’s consensus accomplishment goals. Differences between efficiency scores among insurers were not explained because of a higher proportion of difficult to manage HIV enrollees.