Date: Marzo 2026

ISSN: 2256-5787 (Online)

Authors: Manuel Fernández & Anghella Rosero

Abstract

This study examines the impact of insurer congestion and quality on healthcare service utilization. We exploit the 2015 closure of one of Colombia’s largest insurers, which led to the reallocation of its members to various insurers within the same municipalities. Consequently, the receiving entities experienced a sudden and unexpected influx of new affiliates, leading to varying levels of pressure, or “congestion”. Using a difference-in-differences empirical strategy, we analyze changes in healthcare utilization among reallocated individuals before and after the liquidation. Our study yields three main findings: (1) individuals transferred to more congested insurers experienced a relative decline in healthcare utilization compared to those assigned to less congested insurers; (2) individuals allocated to higher-quality insurers exhibited increased healthcare utilization relative to those assigned to lower-quality insurers; (3) high-quality insurers mitigated the adverse effects of congestion. These patterns in healthcare utilization are consistent across multiple types of services, including consultations, procedures, emergency care, and hospitalizations. Overall, our findings highlight the negative consequences of insurer closures for healthcare service utilization and underscore the critical role of insurer quality in large-scale reallocations.

Keywords

Quality healthcare, insurance, service utilization, universal coverage.