Consultancy to provide technical support to the Ministry of Health and Social Protection in the design of a new methodology for calculating the Capitation Payment Unit in the General Social Security Health System in Colombia

Description

The Inter-American Development Bank (IDB), in coordination with the Ministry of Health and Social Protection (MSPS) of Colombia, calls on consulting firms to submit proposals to provide technical support in the analysis, design, simulation and validation of a new methodology for calculating the Capitation Payment Unit (UPC) based on statistical and actuarial criteria, aimed at its application as of 2027.

1. Comprehensive diagnosis and review of experiences
Evaluation of the current methodology (2022–2026): Analyze the evolution of the current UPC formula, evaluating actuarial assumptions, sources of information, statistical procedures, and limitations on the actual behavior of health spending.

International Comparative Analysis: Review international methodologies in premium calculation, estimation of expected expenditure, compensation mechanisms and risk adjustment models transferable to the Colombian system.

Data purification and quality: Carry out a quality diagnosis of the sector's data sources and implement statistically significant techniques that allow correcting and purifying the information without discarding it.

2. Design of the new methodology and actuarial models
Incorporation of risk variables: Identify and integrate risk adjusters based on epidemiological profile, disease burden, morbidity, consumption of technologies/drugs, territorial variables, and health outcomes.

Simulations and sensitivity analysis: Propose and estimate the new UPC calculation model, running simulations on historical series and robustness tests against key scenarios or assumptions.

Fiscal and financial impact assessment: Estimate the effects of the new model on total health spending, its sources of financing, and the fiscal sustainability of the system compared to the current methodology.

3. Institutional validation and technical transfer
Inter-institutional coordination: Adjust the methodological proposal based on working groups and technical reviews with the MSPS, ADRES, Ministry of Finance and Public Credit, IETS, DNP and other relevant actors.

Application and instruction manual: Deliver the consolidated technical documentation, actuarial specifications, formulas and the application instructions and periodic update for the operational autonomy of the MSPS.

Note: Interested companies should review the requirements on the BEO Bidder Portal.