Unveiling the truth: is COVID-19 reimbursement in Colombia a flawed design? A cost-of-illness analysis for moderate, severe and critical infections.

PURPOSE: This study examines the financial impact of the COVID-19 pandemic on the Colombian Health System, focusing on the adequacy of reimbursement rates for inpatient stays. The study, based on a cost of illness analysis, aims to evaluate the effectiveness of the reimbursement scheme and identify potential economic losses within the health system. PATIENTS AND METHODS: The study protocol outlines the inclusion criteria for patients >18 years with confirmed COVID-19 infection and moderate to critical disease. Patients hospitalised between June 2020 and June 2021 for at least 24 hours were included. Exclusion criteria involved pregnant patients and those initially hospitalised for non-COVID-19. RESULTS: The study included 781 patients contributing to 790 hospitalisations. Demographic and clinical characteristics were analysed, with critical illness being the most prevalent category (61%). The overall mortality rate was 20.3%, primarily observed in critically ill patients. In the general ward for moderate cases, the reimbursement rate saw a substantial increase from US$3237 in 2020 to US$6760 in 2021, surpassing median resource utilisation. However, for severe cases in the intermediate care unit, reimbursement rates decreased, indicating potential insufficiency in covering costs. In the intensive care unit for critical cases, despite improved reimbursement rates, median resource utilisation still exceeds the 2021 rate, suggesting financial insufficiency in reimbursement rates. CONCLUSION: Our study underscores the inadequacies of the previous reimbursement system in addressing the varying resource utilisation and costs associated with COVID-19 inpatient care. Our analysis reveals substantial discrepancies between estimated costs and actual resource utilisation, particularly for severe and critical cases. We advocate for government flexibility in revising reimbursement baskets, supported by pilot studies to assess effectiveness. The use of real-world evidence forms a crucial basis for informed adjustments to reimbursement levels in preparation for future pandemics. This proactive approach ensures alignment between reimbursement policies and the actual costs associated.

A comparison of resource use of insured and uninsured venezuelan migrants: evidence from the hospital setting.

BACKGROUND: There is no characterization of resource use in the hospital setting for immigrants in Colombia, we aimed to describe the resource use by Venezuelan immigrants, comparing those enrolled in the national health insurance system with those with and without the ability to pay. METHODS: Retrospective review in the billing data system of our Hospital from 2011 to 2020. We collected information for 6,837 hospital episodes associated with 1,022 Venezuelan patients, hospital's billing information for all services rendered was extracted. RESULTS: The mean cost per patient event were 4,595 USD for those without the ability to pay, costing 2.37 times more than a legal resident insured. Care in the ICU, inpatient days, surgery, and OB-GYN department consume most resources provided to vulnerable migrants. DISCUSSION: Enrolment in the national health insurance may allow better access to health services by vulnerable Venezuelan migrants and thus reduce resource use for the health system.

Decreases in resource use after implementing an interdisciplinary management program for patients with placenta accreta spectrum.

OBJECTIVE: Placenta accreta spectrum (PAS) often causes severe morbidity and demands the availability of abundant health resources. Research has shown that the participation of experienced interdisciplinary groups in specialized centers improves clinical outcomes. Our objective is to measure resource use variation after implementing an interdisciplinary management program for this condition. METHODS: Using detailed billing information, hospital care resource use was measured at constant prices for women with PAS who were treated between 2011 and 2019. Cases were classified before (Group 1) and after (Group 2) the implementation of the program. A third group included women with intraoperative MAP findings (Group 3). Comparisons were made using descriptive statistics. RESULTS: The mean reduction in resource use after the program was 16.5% per patient. The program also reduced variability in resource use as measured by the standard deviation and the coefficient of variation, which decreased by 55.2% and 46.3%, respectively. CONCLUSION: The interdisciplinary management of patients affected by PAS in experienced hospitals is associated with a reduction in resource use and variability.