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Luck of the Draw: The Causal Effect of Physicians on Birth Outcomes

Author

Listed:
  • Christian Posso
  • Jorge Tamayo
  • Arlen Guarin
  • Estefania Saravia

Abstract

Identifying the impact of physicians on health outcomes is a challenging task due to the nonrandom sorting between physicians, hospitals, and patients. We overcome this challenge by exploiting a Colombian government program that randomly assigned 2,126 physicians to 618 small hospitals. We estimate the impact on the 256,806 children whose mothers received care in those hospitals during their pregnancy, using administrative data from the program, hospitals’ vital statistics records, and physicians’ records from mandatory health-specific graduation exams. We find that more-skilled physicians improve health at birth outcomes. That is, being assigned a physician with a one standard deviation higher performance in the health graduation exam scores decreases the probability of giving birth to an unhealthy baby by 6.31 percent. We present evidence that an underlying mechanism includes improving the targeting of care toward the more vulnerable mothers. **** La asignación de médicos, hospitales y pacientes no suele ser aleatorio, por lo que identificar la importancia de los médicos en la salud de sus pacientes no resulta trivial. En este documento aprovechamos la asignación aleatoria de 2.126 médicos a 618 hospitales pequeños, que se realizó en Colombia a través del Servicio Social Obligatorio (SSO), para estimar el impacto de las habilidades de los médicos en la salud al nacer de los 256.806 bebés cuyas madres recibieron atención en dichos hospitales durante su embarazo. Para este análisis, utilizamos datos administrativos del programa SSO de los años 2013 y 2014, registros de estadísticas vitales y los puntajes en la prueba de medicina de la prueba estandarizada Saber Pro. El resultado principal muestra que los médicos más hábiles mejoran la salud de los niños al nacer. Específicamente, la asignación de un médico que obtuvo un puntaje en la prueba de medicina (Saber Pro) una desviación estándar superior a la media, disminuye la probabilidad de dar a luz a un bebé no sano en un 6,31%. Adicionalmente, encontramos que este resultado es explicado por una mejor focalización de los controles prenatales hacía las madres más vulnerables.

Suggested Citation

  • Christian Posso & Jorge Tamayo & Arlen Guarin & Estefania Saravia, 2024. "Luck of the Draw: The Causal Effect of Physicians on Birth Outcomes," Borradores de Economia 1269, Banco de la Republica de Colombia.
    • Handle: RePEc:bdr:borrec:1269
    DOI: 10.32468/be.1269
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    More about this item

    Keywords

    physicians’ health skills; health at birth outcomes; experimental evidence; habilidades de los médicos; salud al nacer; evidencia de experimentos aleatorios;
    All these keywords.

    JEL classification:

    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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