# The impact of periodic updates to health benefits plan: access gains without cost savings?

## TL;DR

Updating health benefit plans increases access to care but does not save costs, according to a study in Colombia using administrative data.

## Contribution

The study provides new evidence on the effects of periodic health benefit plan updates on access and costs in a real-world setting.

## Key findings

- Inclusion in the HBP-CPU increased healthcare utilization and access, especially in remote areas.
- Cost per user remained stable for procedures but rose for medications due to higher demand.
- Periodic HBP updates do not necessarily lead to cost savings, highlighting the need for cost-containment strategies.

## Abstract

Expanding explicit Health Benefit Plans (HBP) is a key strategy for achieving universal health coverage while maintaining financial sustainability. However, little is known about the broader effects of periodic updates to these plans on healthcare utilization, expenditures, and market dynamics. This study examines the impact of including new health technologies in Colombia’s HBP covered by the Capitation Payment Unit (CPU) between 2012 and 2019, using administrative data and a difference-in-differences approach with multiple periods. Our results indicate that inclusion in the HBP-CPU led to a substantial increase in utilization and access, particularly in remote areas, but had mixed effects on expenditures. While the number of unique users and prescription frequency rose significantly, the cost per user remained stable for procedures but increased for medications, likely due to higher demand and market structures. These findings suggest that although periodic HBP updates enhance access and effective coverage, they do not necessarily generate cost savings. Strengthening health technology assessment processes, integrating price regulation policies, and implementing cost-containment mechanisms are essential for ensuring the financial sustainability of health systems that regularly update benefit plans.

The online version contains supplementary material available at 10.1007/s10754-025-09394-7.