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EVALUATING THE IMPACT OF HEALTH CARE REFORM IN COLOMBIA: FROM THEORY TO PRACTICE

By Alejandro Gaviria, Carlos Medina and Carolina Mejía

Abstract

This article presents an evaluation of an ambitious health reform implemented in Colombia during the first half of the nineties. The reform attempted to radically change public provision of health services, by means of the transformation of subsidies to supply (direct transfers to hospitals) into a new scheme of subsidies to demand (transfers targeted at the poorest citizens). Although the percentage of the population having medical care insurance has notably increased, mostly among the poorest, problems of implementation have been numerous. It has not been possible to achieve the transformation of subsidies to supply into subsidies to demand. At the same time, competition has not made it possible to increase the efficiency of many public hospitals, which continue to operate with very low occupation rates, while receiving hefty money transfers. Subsidies increased demand for medical consultations, but have curbed demand for hospitalizations. Nonetheless, subsidies might have adversely affected female´s labor market participation and even household consumption. As a whole, evidence suggests that the health reform has been effective in rationalizing households´ demand for health, but not in rationalizing public supply, and neither in increasing the efficiency of service providers.demand subsidies, targeted social services, instrumental variables

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  1. (1996). A Comparative Systems Perspective on Health Promotion and Disease Prevention. Oral Health Promotion: Social Sciences in action.
  2. (1974). A Framework for the Study of Access to Medical Care.
  3. (1985). Alternative Methods for Evaluating the Impact of Interventions”, in Longitudinal Analysis of Labour Market Data,
  4. (1983). Assessing Sensitivity to an Unobserved Binary Covariate in an Observational Study with Binary Outcome.
  5. (1968). Behavioral Model of Families’ Use of Health Services.
  6. (1996). Canadian national health insurance and infant health.
  7. (1998). Colombia Economic and Social Development Issues for the Short and Medium Term” Colombia, Ecuador, and Venezuela Country Management Unit Latin America and The Caribbean Region,
  8. (2000). Colombia Poverty Study: The Impact of Public Social Expenditure. Latin American Caribbean Region, World Bank,
  9. (1993). Counts of the Milking Woman: We have to Ask Congress to Change the Stories for Accounts” (“Las Cuentas de la Lechera: Hay que Pedirle al Congreso que nos cambie los Cuentos por las Cuentas”) El Tiempo,
  10. (2001). Decentralization and Reform and Health Service: The Colombian Case. (Descentralización y Reforma en los Servicios de Salud: El Caso Colombiano). World Bank Working Paper.
  11. (1983). Does Free Care Improve Adults’ Health? The New England
  12. (2000). Does medical insurance contribute to socioeconomic differentials in health?
  13. (2004). Effects of the end-of-century crises on Colombian households (Efectos de la crisis de fin de siglo sobre los hogares colombianos 1997-2003). Unpublished Draft.
  14. (1999). Environment, Insurance, and access to the subsidized regime in Colombia. (Entorno, aseguramiento y acceso en el régimen subsidiado en Colombia). Corona Foundation, Cendex and Ford Foundation.
  15. (1974). Estimating Causal Effects of Treatments in Randomized and Nonrandomized Studies.
  16. (2000). Evaluation of Sisben: Efficiency, Institutional Efficacy of the Identification, Classification and Beneficiary Selection Processes” Final Report, Ministry of Health
  17. (1980). Health Care in the US: Equitable for Whom? Beverly Hill CA:
  18. (1996). Health insurance eligibility, utilization of medical care and child health.
  19. (2000). Health Insurance Reform in Four Latin American Countries: Theory and Practice” Policy Research Working Paper 2492.
  20. (2003). Health” (“Salud”) Chapter 22 in Colombia: Economic Fundamentals of Peace (Fundamentos Económicos de la Paz),
  21. (1985). How Free Care Reduced Hypertension in the Health Insurance Experiment.
  22. (2003). Impact of Insurance on the use and spending on healthcare in Colombia. (Impacto del Aseguramiento sobre uso y gasto en salud en Colombia). Corona Foundation, Inter American Development Bank, CENDEX, Pontificia Universidad Javeriana.
  23. (1997). Making the Most out of Program Evaluations and Social Experiments: Accounting for Heterogeneity in program Impacts.
  24. (2000). Organization
  25. (2000). Proceedings of the Regional Conferences on Sisben: Integral Evaluation” Department of National Planning and Ministry of Health
  26. (2004). Program Document For a Proponed Second Programmatic Labor Reform and Social Structural Adjustment Loan
  27. (1993). Public Spending on
  28. (1993). RAND Insurance Experiment Group.
  29. (1995). Revisiting the Behavioral Model and Access to Medical Care: Does it matter?
  30. (2004). Sergio y Contreras,
  31. (1998). Social conditions and self-management are more powerful determinants of health than access to care.
  32. (1997). Structured Pluralism: Towards an Innovative Model for the Reform of Healthcare Systems in Latin America” (“Pluralismo Estructurado: Hacia un Modelo Innovador para la Reforma de los Sistemas de Salud en
  33. (2001). Subsidized Health Insurance, Proxy Means Testing and the Demand for Health Care among the Poor in Colombia. Colombia Poverty Report Volume II. World Bank Document.
  34. (2004). The Access to Healthcare Services in Colombia” (“El Acceso a los Servicios de Salud en Colombia”) mimeo, Doctors without Borders, Santafé de Bogotá, Colombia Ravallion,
  35. (1993). The effect of providing health coverage to poor uninsured pregnant women in Massachusetts.
  36. (2000). The Effects of Medicare on Health Care Utilization and Outcomes. Prepared for presentation at the Frontiers
  37. (2004). The Health System in Colombia alter the 100 Law” (El Sistema de Salud de Colombia después de la Ley 100”) mimeo, Public Health School, Universidad del Valle,
  38. (2004). The Impact of Nearly Universal Insurance Coverage on Health Care Utilization and Health: Evidence from Medicare.
  39. (2004). The Impact of Subsidized Health Insurance for the Poor: Evaluating the Colombian Experience Using Propensity Score Matching.
  40. (1994). The Reform of Social Security in Health, Volume 1: Background and Results” (“La Reforma a la Seguridad Social en Salud, Tomo 1: Antecedentes y Resultados”), Carrera Séptima Ltda. Editorial. Santafé de Bogotá.
  41. (2001). The self-employed are less likely to have health insurance than wage earners. So what?
  42. (1997). The technology of birth: health insurance, medical interventions and infant health.
  43. (2004). Using Discontinuous Eligibility Rules to Identify The Effects of the Federal Medicaid Expansions on Low Income Children. The Review of Economics and Statistics.
  44. (2001). What Do We Really Know About Whether Health Insurance Affects Health? University of Chicago publication.
  45. (1988). Withdrawing routine outpatient medical services: effects on access and health.

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