PNS97 BUDGET SUFFICIENCY TO FINANCE HIGH-COST HEALTH TECHNOLOGIES IN COLOMBIA: AN ALTERNATIVE APPROACH

Abstract

The Colombian Ministry of Health (MoH) set an annual budget to finance high-cost health technologies. Total budget for 2020 was calculated in US$ 1108 million. This budget is delivered between health maintenance organizations (HMO), based on a linear and a data panel model, with no adjustments for incidence, improvement of access for patients nor incentives to the disease management. That budget only will be updated based on retrospective market growth rates and was calculated without having in count regulated prices for medications. The objective of this work is to propose an alternative model to the designed by MoH and calculate the difference between both, in order to evaluate the current budget sufficiency. It was assumed a hypothetical HMO with 3 million affiliates. A sample of 10 active substances included in the initial budget calculated by MoH was taken. It was assumed that prices and quantities obtained from public databases were accurate proxies to the variables needed to replicate the current budget model for the hypothetical HMO. Then, based on an alternative model which included adjustments for incidence, improvement in patient access and improvement in diagnostics (data obtained from Global Burden of Disease and Colombian public reports), it was obtained a different budget for the hypothetical HMO. Sensitivity analysis on incidence rates and patient access rates were performed. Potential underestimation of budget with the current model is around 30% in comparison to the alternative model proposed. are sensitive to incidence rates, and it was proposed that budget differences in favor to hypothetical HMO should be part of its technical reserve, which is not considered in the current model. Current budget model does not guarantee the financial sufficiency needed by any Colombian HMO and does not encourage them to make any improvements in terms of risk management.