Study on the concentration, distribution, and persistence of health spending for the contributory scheme in Colombia

Colombia is among the countries with the most robust financial protection against personal health spending in the world, with out-of-pocket spending ranking lowest across OECD countries. We investigate the evolution, distribution, and persistence of health spending by age group, sex, health care setting, health condition and geographic region for more than 19 million users of Colombia's health system between 2013 and 2021. We use average patient-level expenditure data from the Health-Promoting Entities of the Ministry of Health and Social Protection. We applied descriptive statistics techniques, multiple correspondence analysis, factor maps and correlations. For both sexes, average health expenditure increases gradually with age until the age of 60 years, accelerating thereafter abruptly. Health conditions with the highest percent of expenditure were those related to neoplasms, blood diseases, circulatory system, pregnancy, puerperium and perinatal period. We found that home-based care in AmazoníaOrinoquía is almost non-existent, and that outpatient care has had a high proportion in all age groups (over 65%) compared to the other regions. There is a strong persistence of expenditure between one year and its preceding periods (i.e. they can provide relevant information for prediction), especially in areas with the largest supply of health services such as Bogotá Cundinamarca.