1. En el Sistema general de seguridad social colombiano: CARACTERIZACIÓN DE LOS RECOBROS POR TUTELAS Y MEDICAMENTOS NO INCLUIDOS EN LOS PLANES OBLIGATORIOS DE SALUD.
- Author
-
Masis, Diana Pinto and Castellanos, María Isabel
- Subjects
- *
PHARMACEUTICAL services insurance , *OPPORTUNITY costs , *COST control , *HEALTH care rationing , *SOCIAL security , *GOVERNMENT agencies ,HEALTH insurance finance - Abstract
This study describes the recovery by insurance companies, from the Ministry of Social Protection's Fondo de Solidaridad y Garantía, of expenses for medications not covered by benefits packages or from interventions mandated through court rulings. Estimates of frequency, total value and per capita values of claims by insurer, diagnostic group, medication, and intervention were obtained from claims auditing data available at the Ministry for the year 2002 and part of the year 2003. The opportunity costs of these claims in terms of the number of persons that could be enrolled in current insurance schemes were also calculated. The study finds that claims have been increasing in frequency and value, are concentrated in a few insurers, are related to new technologies for diagnostic groups that are not prevalent in the general population, and that their opportunity costs are not negligible. The results could be explained by changes in the epidemiologic profile of the population, clinical practice patterns, administrative skills of insurers, or incentives to obtain rents. [ABSTRACT FROM AUTHOR]
- Published
- 2004