Analysis of the financial situation of the maximum budgets of the Health‐Promoting Entities in Colombia.

Using a financial‐actuarial approach, a formal methodological proposal is presented, using to estimate the loss ratio of the maximum budgets, an ex‐ante financing mechanism for the health promoting entities (HPEs) of the contributory, and subsidized schemes of the General System of Social Security in Health in Colombia. Using public information from the financial statements of the HPEs, available on the website of the National Health Superintendency, the loss ratios for the years 2020 and 2021 were calculated. The results showed values above 150% for more than 40% of the HPEs analyzed. This generates a financial sustainability alert for the health sector regarding this specific mechanism. To ensure the efficiency of spending and guarantee the fundamental right to health of all inhabitants of the Colombian territory, it is proposed to invest more in the assessment of health technologies, use the cost‐effectiveness threshold already estimated for Colombia, establish clinical guidelines for health technologies not included in the Capitation Payment Unit, and update the health benefit plan in a systematic, participatory, and clear manner for all strategic actors. Key points: The Colombian health system, seen as a whole, had an increase in its maximum budgets claims ratio between 2020 and 2021, going from 115.62% to 119.92%, which is mainly related to the increase in costs—after discounting the release of reserves—which increased by 88.43% during the analysis period, while revenues increased by 81.67% for the same period.Correct usage of information can generate evidence‐based solutions to the current issues of healthcare expenditure growth in the country.The design of strategies, the construction of statistical‐actuarial methodologies, and the application strategy of future sources of financing for non‐Capitation Payment Unit health services and technologies should be studied in‐depth to achieve financial sustainability in the Colombian health system. [ABSTRACT FROM AUTHOR]