La administración cuantitativa del riesgo financiero en la provisión de un plan de salud
Resumen
El diseño del sistema de seguridad social en salud y su efectiva implementación
es uno de los más grandes retos de la sociedad, y a su vez es la principal garantía del goce efectivo del derecho a la salud. Un gran desafío de estos sistemas es la administración del riesgo financiero implícito en la provisión de los servicios de salud. Este documento ilustra en qué medida este desafío se puede enmarcar dentro de un problema de administración cuantitativa de los riesgos financieros. Si bien el uso de estas herramientas no son nuevas en el diseño del sistema de seguridad social en salud colombiano, es importante dar claridad sobre el alcance que han tenido estas herramientas, las posibles mejoras que se puedan hacer y los desafíos, en la gestión de estos riesgos, implícitos en la reforma actual de la institucionalidad del sistema.
The design of a healthcare system and its implementation are one of the most significant challenges for a society. At the same time it is the main guarantee of the right to proper health services for the members of society. Perhaps, the biggest challenge in designing such systems is to manage the financial risk in the provision of health services. This document illustrates how such challenge can be approached through the use of quantitative risk management tools. Although these tool have been in used in the design of the current healthcare system in Colombia it is important to identify them, provide additional tools to attack specific problems in the system and look at the challenges ahead, especially those related to risk management in current healthcare reform.
The design of a healthcare system and its implementation are one of the most significant challenges for a society. At the same time it is the main guarantee of the right to proper health services for the members of society. Perhaps, the biggest challenge in designing such systems is to manage the financial risk in the provision of health services. This document illustrates how such challenge can be approached through the use of quantitative risk management tools. Although these tool have been in used in the design of the current healthcare system in Colombia it is important to identify them, provide additional tools to attack specific problems in the system and look at the challenges ahead, especially those related to risk management in current healthcare reform.
