Evolution and financial burden between 2010-2021

An investigation published by Banco de la Republica analyzed the evolution and financial burden of Chronic Noncommunicable Diseases (CNCDs) and how they can affect the financial burden of the country’s health sector.

The information collected from the Health Benefits Information System (RIPS) included cancer, diabetes, cardiovascular diseases, chronic respiratory diseases and chronic kidney diseases, from 2010 to 2021.

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How have CNCDs evolved?

The evidence shows that over the years the number of people seen in consultations has increased for all CNCDs, with the highest rate being cardiovascular diseases, as we can see in the following graph:

Cardiovascular diseases share risk factors with other diseases such as cancer. In this sense, people with chronic respiratory diseases are more likely to develop heart disease. However, chronic kidney disease is the one with the highest annual growth rate (27%) between 2010 and 2019, followed by diabetes (14%) and cancer (14%).

Women are the ones who go to the consultations the most, between 2010 and 2021, 61% of the patients are women, 38.9% men and 0.1% others. In this period, 60% of cancer consultations correspond to women, 59% of diabetes, 63% of cardiovascular, 54% of chronic respiratory disease and 54% of chronic kidney disease.

The investigation indicates that, despite the fact that the consultations are mostly from the contributory regime, in recent years the growth of affiliates who consult from the subsidized regime has been evident.

The participation of cancer patient consultations in the subsidized regime went from 21.8% in 2010 to 35.1% in 2019; for diabetes it increased from 25.7% to 38.4%, for cardiovascular disease from 29.6% to 40.6%, for chronic respiratory disease from 33.4% to 45.5% and for kidney disease chronic from 20.1% to 26.2%, respectively.

The Map shows that in 2019 the departments with the highest rates of care for CNCDs are Antioquia, Risaralda, Valle del Cauca, Caldas and Bogotá. However, there are departments that present annual growth rates of consultations for these diseases, between 2010 and 2019, higher than 20%.

In matters of hospitalization and emergencies, the number of people treated shows a growing trend until 2019 in all CNCDs, with cardiovascular diseases and chronic respiratory disease standing out. Between 2010 and 2019, people seen in the emergency room and hospitalizations grew at an average annual rate of 9% and 16%, respectively.

In relation to the distribution by sex, in the period analyzed, the emergency services and hospitalizations have treated more women than men, 55% and 52% respectively. However, differences are observed between CNCDs, highlighting chronic kidney disease, which on average is 13 percentage points higher in men than in women.

Who uses the health system?

The use of the system per person indicates the demand that exists, which when increased represents a financial burden for the health system. Between 2010 and 2019, consultations for cancer cases increased from 2.9 appointments to 4.0 appointments, and for chronic kidney disease, from 2.6 appointments to 3.2 appointments.

Regarding procedures and hospitalizations, those who used the services the most were patients with cardiovascular disease. While, in the emergency room, there was an increase in care for chronic respiratory disease, going from 1.38 visits to 1.43 visits.

What was the associated cost of CNCDs?

To estimate the health system care costs associated with CNCDs, information from the RIPS, the tariff manual, and the sufficiency base were taken as a basis. The total cost associated with CNCDs was then projected through 2030 to determine the future financial burden for the health sector.

The costs per person served, which grow up to 2018, decrease in 2019 and increase from that year on.

Projections to 2030 of Chronic Noncommunicable Diseases

The study projected the total costs in 3 scenarios; the first, due to the growth of the people served; the second, assuming the attentions plus the inflation estimated in the survey of economic expectations; and finally, an increase of 0.456% corresponding to the technical change was added to these variables.

It was concluded that the total costs attributed to CNCDs in trillions of pesos in 2021, without considering medicines, would reach $9.3 trillion in scenario 1, $9.8 trillion in scenario 2, and $10.2 trillion in scenario 3 by 2030. ; in 10 years the total costs would increase by about 40%.

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