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Subsidized Health Care and Food Security: Evidence from Colombia

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  • Camilo Bohorquez-Penuela

    (Banco de la República de Colombia)

Abstract

In 1993, the Colombian Government created a subsidized health care regime (SR) in order to increase coverage among the poorest population. Using data from the 2008 and 2012 Colombian Living Standards Survey, I estimate the association between SR participation and household food insecurity. Enrollment into the SR is not exogenous due to self-selection from potentially eligible households, discretionary municipalitylevel policies that affect eligibility, and manipulation of the assignment process for electoral purposes. Therefore, I use the proportion of lifetime the household head has resided in the current municipality as an instrumental variable. Taking the uninsured population as the comparison group, the two-stage least squares regression estimates reveal that participation in the SR is associated with a reduction of the probability of being food insecure, principally in rural areas. This result is robust to different specifications and, moreover, prevails after implementing an imperfect instrumental variables approach **** RESUMEN: En 1993, el gobierno colombiano creó un régimen de salud subsidiada (RS) con el objetivo de mejorar la cobertura de salud sobre la población más pobre y vulnerable. Usando datos de la Encuesta de Calidad de Vida (ECV) para los años 2008 y 2012, estimo la asociación entre la participación en el RS y la seguridad alimentaria de los hogares colombianos. El proceso de enrolamiento en el RS no es exógeno, porque se encuentra sujeto a auto-selección por parte de los hogares potencialmente elegibles, políticas discrecionales por parte de los municipios con respecto a la focalización del programa, y la manipulación del puntaje que determina la asignación por parte de políticos locales debido a motivos electorales. Por lo tanto, uso la proporción del tiempo de vida que el jefe de hogar lleva residiendo en el municipio como variable instrumental. Tomando la población no asegurada como el grupo de control, las estimaciones por medio de mínimos cuadrados en dos etapas muestran que la participación en el RS está positivamente correlacionada con una reducción en la inseguridad alimentaria de los hogares colombianos, principalmente en áreas rurales. Este resultado es robusto a varias especificaciones econométricas y, más aún, después de implementar una metodología para instrumentos imperfectos.

Suggested Citation

  • Camilo Bohorquez-Penuela, 2020. "Subsidized Health Care and Food Security: Evidence from Colombia," Borradores de Economia 1103, Banco de la Republica de Colombia.
  • Handle: RePEc:bdr:borrec:1103
    DOI: https://doi.org/10.32468/be.1103
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    1. Aviv Nevo & Adam M. Rosen, 2012. "Identification With Imperfect Instruments," The Review of Economics and Statistics, MIT Press, vol. 94(3), pages 659-671, August.
    2. Antonio Trujillo & Jorge Portillo & John Vernon, 2005. "The Impact of Subsidized Health Insurance for the Poor: Evaluating the Colombian Experience Using Propensity Score Matching," International Journal of Health Economics and Management, Springer, vol. 5(3), pages 211-239, September.
    3. Joshua D. Angrist & Jörn-Steffen Pischke, 2009. "Mostly Harmless Econometrics: An Empiricist's Companion," Economics Books, Princeton University Press, edition 1, number 8769.
    4. DiNardo, John & Lee, David S., 2011. "Program Evaluation and Research Designs," Handbook of Labor Economics, in: O. Ashenfelter & D. Card (ed.), Handbook of Labor Economics, edition 1, volume 4, chapter 5, pages 463-536, Elsevier.
    5. World Health Organization & World Bank, 2017. "Tracking Universal Health Coverage," World Bank Publications - Books, The World Bank Group, number 29042, December.
    6. José Luis Montiel Olea & Carolin Pflueger, 2013. "A Robust Test for Weak Instruments," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 31(3), pages 358-369, July.
    7. White, Halbert, 1980. "A Heteroskedasticity-Consistent Covariance Matrix Estimator and a Direct Test for Heteroskedasticity," Econometrica, Econometric Society, vol. 48(4), pages 817-838, May.
    8. Robert Kaestner & Darren Lubotsky, 2016. "Health Insurance and Income Inequality," Journal of Economic Perspectives, American Economic Association, vol. 30(2), pages 53-78, Spring.
    9. Grant Miller & Diana Pinto & Marcos Vera-Hernández, 2013. "Risk Protection, Service Use, and Health Outcomes under Colombia's Health Insurance Program for the Poor," American Economic Journal: Applied Economics, American Economic Association, vol. 5(4), pages 61-91, October.
    10. Christian Dippel & Robert Gold & Stephan Heblich & Rodrigo Pinto, 2017. "Instrumental Variables and Causal Mechanisms: Unpacking the Effect of Trade on Workers and Voters," CESifo Working Paper Series 6816, CESifo.
    11. McGee, Rosemary, 1999. "'Technical, Objective, Equitable, and Uniform'? A Critique of the Colombian System for the Selection of Beneficiaries of Social Programmes, Sisben," General Discussion Papers 30570, University of Manchester, Institute for Development Policy and Management (IDPM).
    12. Abhijit Banerjee & Angus Deaton & Esther Duflo, 2004. "Wealth, Health, and Health Services in Rural Rajasthan," American Economic Review, American Economic Association, vol. 94(2), pages 326-330, May.
    13. Cuesta, Jose & Olivera, Mauricio, 2014. "The impact of social security reform on the labor market: The case of Colombia," Journal of Policy Modeling, Elsevier, vol. 36(6), pages 1118-1134.
    14. Orazio Attanasio & Alice Mesnard, 2006. "The Impact of a Conditional Cash Transfer Programme on Consumption in Colombia," Fiscal Studies, Institute for Fiscal Studies, vol. 27(4), pages 421-442, December.
    15. Alejandro Gaviria & Carlos Medina & Carolina Mejia, 2006. "Assessing Health Reform in Colombia: From Theory to Practice," Economía Journal, The Latin American and Caribbean Economic Association - LACEA, vol. 0(Fall 2006), pages 29-72, August.
    16. Adriana Camacho & Emily Conover, 2013. "Effects of Subsidized Health Insurance on Newborn Health in a Developing Country," Economic Development and Cultural Change, University of Chicago Press, vol. 61(3), pages 633-658.
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    More about this item

    Keywords

    Colombia; food security; public health care; Colombia; salud pública; seguridad alimentaria;
    All these keywords.

    JEL classification:

    • D12 - Microeconomics - - Household Behavior - - - Consumer Economics: Empirical Analysis
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs

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