Abstract

ZULUAGA-RAMIREZ, Mónica Márcela; MACEDO-IVANAUSKAS, Terry; FAGUNDES-FERREIRA, Fernando  and  RODRIGUES-NETO, Camilo. The cost impact of a private insurer's own network upon outpatient care. Salud pública Méx [online]. 2015, vol.57, n.5, pp.426-432. ISSN 0036-3634.

Objective. Econometric analysis that seeks to measure the cost impact of a private insurer's own network upon outpatient care for its policyholders, own network refers to vertical integrated providers. The purpose is to assess whether greater use of its own network reduces the costs that the insurer incurred, according to what specialized literature suggests. Materials and methods. Study based on a multiple linear regression on data from a private insurer. The dependent variable is per capita cost of outpatient services. The explanatory variables are adherence to the own network and a number of variables to specify better the model. Results. With all other factors constant, in relation to covering the costs of outpatient care, it is noted that policyholders with high adhesion to their own network are less expensive than whose with low adhesion. Conclusions. The decision-making process about what services and what grade should be applied to each person by special conditions of the offer as the aggregation of human resources in own offices under formal rules has an impact on health care costs. Particular supply conditions cause variations in how resources are used.

Keywords : health care cost; ambulatory health service; health insurance; ambulatory care facilities; regression analysis; Colombia.

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