OBJECTIVES: the objective of this study is to characterize the population of a Colombian voluntary insurance company under a risk based adjustment methodology to improve population management and determine if there are significant characterization differences compared with a mandatory insurance company.

METHODS: starting with ambulatory and hospital care registers during a whole year (2016), complemented with information from attentions on mandatory insurance, algorithms were applied based on key diagnosis and consumptions in order to classify each individual according risk levels. The characterization allows grouping population on aggregation levels, risk levels and clinical pathologies, so that is possible to perform a correct risk management of the voluntary insurer population. Classification rules were applied according international standards and by means of a mathematical model its statistical consistency was tested.

RESULTS : the totality of affiliate users was characterized (257.349), with an average age of 38 years, and man-woman ratio of 1:1.2. On the first aggregation level the found risk distribution was 83.83%, 14.11% and 2.05% on patients without chronic disease, with one chronic disease and multiple chronic diseases. On the other hand, on the second level of aggregation the population was consolidated on the group of young adults (22.34%), participation of the total affiliate population. The chronic disease group with more participation on were the groups of osteoarticular disease with 3.91% of the affiliate users, and hypertension with 3.80% of the total users. From the total population analyzed, 22.13% was characterized a population without chronic disease.

CONCLUSIONS : it was possible to build a characterization model on two levels of aggregation that, allows to improve risk management of affiliated population to a voluntary insurer based on policies focused in prioritized groups due to its concentration. The results are different than the ones of the mandatory insurer which makes more valuable its application