Trujillo Antonio J, McCalla Dawn C
Health Services Administration, University of Central Florida, USA.
J Policy Anal Manage. 2004 Aug;23(4):873-88. doi: 10.1002/pam.20052.
One of the primary objectives of Colombian social health insurance reform was to increase competition among for-profit insurers. Unfortunately, the flat capitated formula creates an opportunity for sickness funds to maximize reimbursement gains by cream skimming--selecting against unhealthy individuals. This paper explores sickness fund selection behavior to evaluate the efficiency losses associated with the introduction of managed competition in Colombia. Data from a 1997 Colombian household survey are analyzed with a bivariate probit model with partial observability using instrumental variables. The model yields some evidence of sickness fund selection based on health status. Public policy options to discourage risk selection by health status are discussed.
哥伦比亚社会医疗保险改革的主要目标之一是增强营利性保险公司之间的竞争。不幸的是，统一的人均费用公式为疾病基金通过撇脂策略（即排斥不健康个体）来最大化报销收益创造了机会。本文探讨疾病基金的选择行为，以评估与在哥伦比亚引入管理式竞争相关的效率损失。利用工具变量，通过具有部分可观测性的双变量概率模型对1997年哥伦比亚家庭调查的数据进行了分析。该模型得出了一些基于健康状况进行疾病基金选择的证据。文中还讨论了抑制按健康状况进行风险选择的公共政策选项。
