ABSTRACT

The inefficiency in the utilization of the available resources, the distribution of these resources toward cost-ineffective interventions, the inequity in the access to the services, and the growing costs of health (that do that the aggregate expense of the sector grow to a rhythm over that of the income), are barely some of the causes of the deficit of the systems of health.

Colombia has one of the best systems for protection against illnesses called “ruinous” or “disastrous” (ERC 2 ), which represent high technical complexity in its management, high cost, low occurrence and under cost-effectiveness in its processing, covering today to the 57% of all the population, this is at more than 20 million inhabitants.

In transit, such protection permits to the system to arrange of more than 40 million euros to guarantee also the technological and scientific development of the medicine of higher complexity in the country.

The knowledge of the dynamics of the behavior of the health services demand for the treatment of the ERC and one more real dimensioning of the offering with regard to the demand they will permit to contribute to the solution of the problem of the inefficiency in the utilization of the resources of health in Colombia for this group of pathologies.

Consequently, this Thesis is focused in the design of a model of prospective simulation of the behavior of the variables related to the health services demand for the processing of ERC in the Colombian’s Health Social Security System, applicable inside the population affiliated to a Colombian’s Health Promoter Company (Cruz Blanca EPS), to predict the health services demand by this concept that allows planning, estimating of budget and the efficient and effective organization of the productive system (dimensioning of the offering) of said services in the five-year period 2002-2006.

1 EPS: “Entidad Promotora de Salud” (it’s some kind of HMO).

2 ERC: “Enfermedades Ruinosas o Catastróficas” © Walter Toro (wtoro@etb.net.co) xi This model of simulation worked with the methodology applied to the prospective of Settings (investigation of future), with technical tools of: structural analysis of systems, analysis of mobility and dependence of variables, crusader impact headquarters, actors strategy analysis, forecast of variables, morphologic analysis, methods of experts with corrected probabilities, modeling simulated, and exploratory prospective.

As result the approach of a model was obtained simplified of simulation of the system studied (Cruz Blanca EPS and its environment) that would be able to be moved iteratively through regressions introducing changes in any of its variables to observe the behavior of the resultant variable (output), that is the cost generated by the treatment of ERC. Also three settings were defined (potential) that conform an exploratory prospective of the possible thing (not improbable) about the future behavior of the ERC and the problematic one of costs that they generate, keeping in mind the weight of the determinisms of the past and the confrontation of the projects of the actors. Each setting (a coherent play of hypothesis) of the prospective can be object of an appreciation coded in future investigations.

Key words: Simulation, Prospective, Settings, Future, Demand, ERC, Disastrous Illnesses, EPS, Cruz Blanca, Cost, Colombia.

Model de simulació prospectiva de la demanda de servicis de salut per a malalties d'alt cost: aplicació per a una entitat promotora de salut colombiana.