Health for all? A cost-utility evaluation of Colombia's policy to enroll Venezuelan migrants (2021–2023)

Introduction: From 2021 to 2023, Colombia implemented a national policy to expand health insurance coverage for over 1.4 million Venezuelan migrants through its subsidized health insurance system, which provides universal health coverage to low-income Colombian populations. This study evaluates the cost-utility of the intervention, focusing on its health and economic returns. Methods: We conducted a cost-utility analysis by translating government expenditure per enrolled migrant into health outcomes (QALYs/YLLs) using Colombia-specific cost-effectiveness thresholds. Health benefits were measured in quality-adjusted life years (QALYs) gained and years of life lost (YLLs) averted. Colombia-specific cost-effectiveness thresholds (CETs) were used to estimate outcomes, and an internal rate of return (IRR) analysis assessed the program's social profitability. Results: The intervention generated an estimated 10,259 QALYs gained or 11,843 YLLs averted between 2021 and 2023. The IRR reached 27.5% when QALYs were valued at 100% of Gross Domestic Product per capita, indicating strong social returns. Women and adults aged 19–44 showed the greatest health gains, with urban areas receiving the highest benefits. This evidence demonstrates that even health policies can yield high social returns, providing a model for other countries navigating large-scale migration. Discussion: Expanding subsidized health insurance to migrants proves to be a highly cost-effective policy. This analysis supports Colombia’s approach as a scalable and impactful model for inclusive public health aligned with universal health coverage goals.