Presentation in which we try to analyze and reverse engineer the economic engine of the Bienestar Social Business in Caldas, Colombia.

1. BIENESTAR:
Reverse Engeneering Analysis
D4SB Group - IED Milano - Alberto Cottica - April 28, 2011

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

3. 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.

4. 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

5. RESEARCH...

6. 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

7. Reduction of Caldas’ population Factors:
estimated decrease of 0.2% annually • low birth rate
between the years 2006 and 2020. • reduction of infant mortality
• high life expectancy rate
• national migratory patterns
RESEARCH

8. All rights reserved by Diego Torquemada
Combined effect
of mortality and migration
In Caldas: However, for every 4 births there are 3
1 death for every 3 births which means migrations, meaning very low population
positive net natural growth. growth rate.
(growth rate = natural growth – net
migration).
RESEARCH

9. 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

10. 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

11. 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

12. All rights reserved by Diego Torquemada
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

13. 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
RESEARCH

14. All rights reserved by Diego Torquemada
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

15. Villamaría
• ~50.000 inhabitants
• 35.000 urban
• 15.000 rural
RESEARCH

16. Professionals working in health industry in Vilamaria
(rate per 1000 inhabitants)
Doctors: 0,48 Dentists: 0,22
Nurses: 0,12 Nursing assistance: 0,78
RESEARCH

17. Patients treated in 2009 by health institutions in Vilamaria
Hospital San Antonio: 41.173 Centro Medico El Parque: 19.540 Public: 41.173
Pasbisalud: 16.383 SOS Confamiliares: 6.803 Private: 45.320
Salud Total: n.d
RESEARCH

18. THE NUMBERS...
REVERSE ENGINEERING

19. 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.
ANALYSIS AND CONCLUSIONS

20. 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

21. 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

22. Bienestar & doctors:
• Bienestar potential target should include doctors working for institutions as they can
earn ~59% more.
ANALYSIS AND CONCLUSIONS

23. Bienestar & patients:
• Bienestar’s potential target is 33,550 persons which accounts for the 67% of the total
population of Villamaria.
ANALYSIS AND CONCLUSIONS

24. NEXT STEPS...

25. • 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)