BIENESTAR:Reverse Engeneering AnalysisD4SB Group - IED Milano - Alberto Cottica - April 28, 2011

BRIEF: Reverse engineer the Bienestar economic engine, to validate their business model.

CHALLENGE: Understand current access to primary health care in Colombia, specifically in

Caldas district.

Primary health care = 1st point of visit.

60% cheaper costs for services and medicine.

HOW IT WORKS: Bienestar aims to provide affordable healthcare to the poor in Colombia.

The model is based on the “Ser” system in Argentina:

• a ~$5 membership card for patients/year

• access to a network of doctors and healthcare centers with 60%

cheaper costs for services and medicine

RESEARCH...

Caldas

• It's part of the Paisa Region and its capital is Manizales.

• The population of Caldas is ~1 million, and its area is 7,291 km².

• Part of the Colombian Coffee Grow Axis region along with 2 other departments.

RESEARCH

Reduction of Caldas’ population

estimated decrease of 0.2% annually

between the years 2006 and 2020.

RESEARCH

Factors:

• low birth rate

• reduction of infant mortality

• high life expectancy rate

• national migratory patterns

RESEARCH

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Combined effect

of mortality and migration

In Caldas:

1 death for every 3 births which means

positive net natural growth.

However, for every 4 births there are 3

migrations, meaning very low population

growth rate.

(growth rate = natural growth – net

migration).

RESEARCH

Reasons for migration:

Scarcity in the labor markets of the municipalities.

Profile:

Mainly youth, between the age of 25 - 39

(Iinitially to the capital in search of opportunity, and later to other states or countries.)

The combination of migration and mortality rates explains the population’s reduction in the

younger age groups (particularly 25-39 years old) and the growth in the older age groups.

RESEARCH

Incidence of Poverty in Caldas According to the SISBEN

The state of Caldas has a population of 974,514 inhabitants (June, 2008):

• 250,169 inhabitants were registered in the SISBEN as Level 1 (extreme poverty)

• 354,240 were registered as Level 2 (poor)

(SISBEN assigns a score to the surveyed households based on: level and access to

education, access to the labor market, living conditions, access to public services and to

the social security system.)

RESEARCH

Poverty incidence rate (the total number of poor over the total population):

• proportion of the population in extreme poverty (Level 1 / total population) is 25.7%

• total poverty incidence of Caldas (Level 1 population + Level 2 population) is 62.0%

3 out of every 5 inhabitants of Caldas are poor by definition of the SISBEN index.

Caldas has one of lowest number of incidences of extreme poverty (Level 1) in Colombia.

However, Caldas is the third state in the nation in Level 2 percentage, with a total of 36%,

while the national total is only 25%.

RESEARCH

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Caldas should be characterized as a state with a poor population, but not indigent.

Poverty is not homogeneously distributed; each of the territorial entities that make up the

Coffee Axis exhibit a different composition of poverty levels.

The Magdalena sub region registers a rate of extreme poverty 20 points higher than the

state’s average.

Due to the better living conditions in Manizales, the true poverty levels of the municipalities

of Caldas are disguised.

RESEARCH

Caldas population by zone (June 20, 2009)

• Caldas: Total: 976,438 - Urban Center: 686,905 - Rural: 289,533

• Manizales: Total: 386,931 - Urban Center: 360,020 - Rural: 26,911

• Villamaría: Total: 50,123 - Urban Center: 40,437 - Rural: 9,686

The capital of Caldas, the city of Manizales, accounts for 40% of the total population

and is home to the greatest number of businesses, industrial, educational, and

commercial establishments of the state.

RESEARCH

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RESEARCH

Villamaría

• ~50.000 inhabitants

• 35.000 urban

• 15.000 rural

RESEARCH

Professionals working in health industry in Vilamaria (rate per 1000 inhabitants)

Doctors: 0,48 Dentists: 0,22Nurses: 0,12 Nursing assistance: 0,78

RESEARCH

Patients treated in 2009 by health institutions in Vilamaria

Public: 41.173

Private: 45.320Centro Medico El Parque: 19.540

SOS Confamiliares: 6.803

Salud Total: n.d

Hospital San Antonio: 41.173

Pasbisalud: 16.383

THE NUMBERS...REVERSE ENGINEERING

ANALYSIS AND CONCLUSIONS

Patients:

According to our analysis, poor people suscribed to the Bienestar plan can save up to

43 USD/year compared to regular prices this is a saving of ~42% more.

Doctors:

Doctors that only operate on their own clinics can get an average of 18% increase in their

salary (14,9 times the minimum wage).

Doctors that operate inside institutions (private & public) can increase their salary an

average of ~59% (6,0 times the minimum wage).

ANALYSIS AND CONCLUSIONS

ANALYSIS AND CONCLUSIONS

Bienestar:

• According to our analysis, Bienestar becomes economically sustainable on the

second year, but it doesn’t become finantially sustainable until it’s 4th year of

existance.

ANALYSIS AND CONCLUSIONS

Bienestar & doctors:

• Bienestar potential target should include doctors working for institutions as they can

earn ~59% more.

ANALYSIS AND CONCLUSIONS

Bienestar & patients:

• Bienestar’s potential target is 33,550 persons which accounts for the 67% of the total population of Villamaria.

NEXT STEPS...

• State project goal

• Identify actors (stakeholders map)

• Interview guide / Ask questions

(what questions have not been answered)

• Identify research methodologies to be used in the field.

• Revise strategies with Marta

• Talk to Felipe about projects / ideas / requests for the field trips

(eg. interviews)