Publication:

Propuesta de modelo para el cálculo de la Unidad de Pago por Capitación (UPC) para procedimientos y consultas, que permite el análisis de los factores de riesgo que inciden en la estimación del costo en salud

The UPC in Colombia is defined annually as the result of the risk adjustment to the pure premium, determined by the Ministry of Health and Social Protection based on an analysis of population variables that converge in a linear regression. The outcome of this calculation determines the income received by Health Promoting Entities (Empresas Promotoras de Salud - EPS) to cover the Current Health Benefits Plan. The objective of this work is to present an alternative model proposal for the calculation of the UPC in Colombia for consultations and procedures, based on a Generalized Linear Model (GLM) and the application of the Tweedie distribution, which enables the analysis of the risk factors that influence health costs.