IDEAS home Printed from https://ideas.repec.org/a/wly/jpamgt/v23y2004i4p873-888.html
   My bibliography  Save this article

Are Colombian sickness funds cream skimming enrollees? An analysis with suggestions for policy improvement

Author

Listed:
  • Antonio J. Trujillo

    (University of Central Florida)

  • Dawn C. McCalla

    (University of Central Florida)

Abstract

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. © 2004 by the Association for Public Policy Analysis and Management.

Suggested Citation

  • Antonio J. Trujillo & Dawn C. McCalla, 2004. "Are Colombian sickness funds cream skimming enrollees? An analysis with suggestions for policy improvement," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 23(4), pages 873-888.
    • Handle: RePEc:wly:jpamgt:v:23:y:2004:i:4:p:873-888
    DOI: 10.1002/pam.20052
    as

    Download full text from publisher

    File URL: http://hdl.handle.net/10.1002/pam.20052
    File Function: Link to full text; subscription required
    Download Restriction: no
    File URL: https://libkey.io/10.1002/pam.20052?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Madhu Mohanty, 1998. "Do US employers discriminate against females when hiring their employees?," Applied Economics, Taylor & Francis Journals, vol. 30(11), pages 1471-1482.
    2. Grosh, M.E. & Glewwe, P., 1995. "A Guide to Living Standards Measurement Study Surveys and their Data Sets," Papers 120, World Bank - Living Standards Measurement.
    3. Antonio J. Trujillo, 2003. "Medical care use and selection in a social health insurance with an equalization fund: evidence from Colombia," Health Economics, John Wiley & Sons, Ltd., vol. 12(3), pages 231-246, March.
    4. Dennis G. Shea & R. Patrick Stewart, 1995. "Demand for insurance by elderly persons: Private purchases and employer provision," Health Economics, John Wiley & Sons, Ltd., vol. 4(4), pages 315-326, July.
    5. Randall P. Ellis & Thomas G. McGuire, 1993. "Supply-Side and Demand-Side Cost Sharing in Health Care," Journal of Economic Perspectives, American Economic Association, vol. 7(4), pages 135-151, Fall.
    6. John M. Abowd & Henry S. Farber, 1982. "Job Queues and the Union Status of Workers," ILR Review, Cornell University, ILR School, vol. 35(3), pages 354-367, April.
    7. Poirier, Dale J., 1980. "Partial observability in bivariate probit models," Journal of Econometrics, Elsevier, vol. 12(2), pages 209-217, February.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Ronald Eduardo Gómez Suárez, 2007. "Cream-Skimming And Risk Adjustment in Colombian Health Insurance System:: The Public Insurer Case," Archivos de Economía 4295, Departamento Nacional de Planeación.
    2. Antonio Trujillo & Fernando Ruiz & John Bridges & Jeannette Amaya & Christine Buttorff & Angélica Quiroga, 2012. "Understanding consumer preferences in the context of managed competition," Applied Health Economics and Health Policy, Springer, vol. 10(2), pages 99-111, March.
    3. Christine Buttorff & Antonio J. Trujillo & Fernando Ruiz & Jeannette L. Amaya, 2015. "Low rural health insurance take-up in a universal coverage system: perceptions of health insurance among the uninsured in La Guajira, Colombia," International Journal of Health Planning and Management, Wiley Blackwell, vol. 30(2), pages 98-110, April.
    4. Castano, Ramon & Zambrano, Andres, 2006. "Biased selection within the social health insurance market in Colombia," Health Policy, Elsevier, vol. 79(2-3), pages 313-324, December.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Guifu Chen & Shigeyuki Hamori, 2014. "Bivariate Probit Analysis of the Differences Between Male and Female Formal Employment in Urban China," SpringerBriefs in Economics, in: Rural Labor Migration, Discrimination, and the New Dual Labor Market in China, edition 127, chapter 0, pages 65-76, Springer.
    2. Madhu Mohanty, 2002. "A bivariate probit approach to the determination of employment: a study of teen employment differentials in Los Angeles County," Applied Economics, Taylor & Francis Journals, vol. 34(2), pages 143-156.
    3. Colm Harmon & Claire Finn & Arnaud Chevalier & Tarja Viitanen, 2006. "The economics of early childhood care and education : technical research paper for the National Economic and Social Forum," Open Access publications 10197/671, School of Economics, University College Dublin.
    4. Hiroyuki Takeshima & Rajendra Prasad Adhikari & Anjani Kumar, 2016. "Is Access to Tractor Service a Binding Constraint for Nepali Terai Farmers?," Working Papers id:9604, eSocialSciences.
    5. Dimara, Efthalia & Skuras, Dimitris, 2003. "Adoption of agricultural innovations as a two-stage partial observability process," Agricultural Economics, Blackwell, vol. 28(3), pages 187-196, May.
    6. Katharina Wrohlich, 2008. "The excess demand for subsidized child care in Germany," Applied Economics, Taylor & Francis Journals, vol. 40(10), pages 1217-1228.
    7. Tennekoon, Vidhura S., 2016. "The equivalence of three latent class models and ML estimators," Economics Letters, Elsevier, vol. 141(C), pages 147-150.
    8. Bourguignon, François & Bussolo, Maurizio, 2013. "Income Distribution in Computable General Equilibrium Modeling," Handbook of Computable General Equilibrium Modeling, in: Peter B. Dixon & Dale Jorgenson (ed.), Handbook of Computable General Equilibrium Modeling, edition 1, volume 1, chapter 0, pages 1383-1437, Elsevier.
    9. Michael J. Pisani & José A. Pagán, 2003. "Sectoral Queuing in a Transitional Economy: The Case of Nicaragua in the 1990s," LABOUR, CEIS, vol. 17(4), pages 571-597, December.
    10. Aydemir, Abdurrahman, 2002. "Effects of Selection Criteria and Economic Opportunities on the Characteristics of Immigrants," Analytical Studies Branch Research Paper Series 2002182e, Statistics Canada, Analytical Studies Branch.
    11. Chi, Wuchun & Wu, Shing-Jen & Zheng, Zhen, 2020. "Determinants and consequences of voluntary corporate social responsibility disclosure: Evidence from private firms," The British Accounting Review, Elsevier, vol. 52(6).
    12. Chen, Gongmeng & Firth, Michael & Gao, Daniel N. & Rui, Oliver M., 2006. "Ownership structure, corporate governance, and fraud: Evidence from China," Journal of Corporate Finance, Elsevier, vol. 12(3), pages 424-448, June.
    13. Amir Shmueli, 2001. "The effect of health on acute care supplemental insurance ownership: an empirical analysis," Health Economics, John Wiley & Sons, Ltd., vol. 10(4), pages 341-350, June.
    14. Denis Beninger & Holger Bonin & Julia Horstschräer & Grit Mühler, 2010. "Wirkungen eines Betreuungsgeldes bei bedarfsgerechtem Ausbau frühkindlicher Kindertagesbetreuung: eine Mikrosimulationsstudie," Vierteljahrshefte zur Wirtschaftsforschung / Quarterly Journal of Economic Research, DIW Berlin, German Institute for Economic Research, vol. 79(3), pages 147-168.
    15. Taye Mengistae, 1998. "Wage rates and job queues: does the public sector overpay in Ethiopia?," CSAE Working Paper Series 1998-20, Centre for the Study of African Economies, University of Oxford.
    16. Joris Ghysels & Kim Vercammen, 2012. "The beneficiaries of childcare expansion," Working Papers 1202, Herman Deleeck Centre for Social Policy, University of Antwerp.
    17. Firth, Michael & Rui, Oliver M. & Wu, Wenfeng, 2011. "Cooking the books: Recipes and costs of falsified financial statements in China," Journal of Corporate Finance, Elsevier, vol. 17(2), pages 371-390, April.
    18. Dunli Zhang & Jinzhao Zhou & Jingjuan Ma, 2024. "Ex‐military Top Executives and Corporate Violations: Evidence from China," Abacus, Accounting Foundation, University of Sydney, vol. 60(2), pages 365-398, June.
    19. Przeworski, Adam & Vreeland, James Raymond, 2000. "The effect of IMF programs on economic growth," Journal of Development Economics, Elsevier, vol. 62(2), pages 385-421, August.
    20. Takeshima, Hiroyuki, 2015. "Market imperfections for tractor service provision in Nigeria: International perspectives and empirical evidence:," IFPRI discussion papers 1424, International Food Policy Research Institute (IFPRI).

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:wly:jpamgt:v:23:y:2004:i:4:p:873-888. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/journal/34787/home .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.