IDEAS home Printed from https://ideas.repec.org/p/bfi/wpaper/2026-50.html

The Effects of Intervening the Supply Side of Fraudulent Sick Leaves Market in Chile

Author

Listed:
  • Pablo A. Celhay

    (Pontificia Universidad Católica de Chile)

  • Nicolás Figueroa

    (Pontificia Universidad Católica de Chile)

  • Carla Guadalupi

    (Universidad Andrés Bello)

  • Benjamín Oteíza

    (Pontificia Universidad Católica de Chile)

Abstract

This paper examines the effects of a crackdown on fraudulent sick leave in Chile, where 176 doctors were sanctioned for issuing excessive certificates. Physician decisions are influenced by patient needs and incentives,often resulting in suboptimal care. We analyze whether audits and sanctions change doctor behavior, whether non-sanctioned doctors are affected, and how patient behavior responds. Using data on around 22 million sick leaves from January 2018 to October 2022, we apply difference-in-differences (DiD)and regression discontinuity in time (RDiT) methods. Results show a 40.49%reduction in sick leave issuance among sanctioned doctors (DiD) and decreased between 34.46% and 50.12% (RDiT). We also find spillover effects: non-sanctioned doctors reduced issuing sick leaves by 9.33% to 14.19% after the intervention. On the demand side, patients treated by sanctioned doctors experienced an 18.94% decline in sick leave usage, saving approximately $12.6million for the public insurer. Overall, sanctions on doctors effectively reduced sick leave issuance, partly due to patients switching providers, highlighting how supply-side interventions can influence healthcare practices and patient behavior.

Suggested Citation

  • Pablo A. Celhay & Nicolás Figueroa & Carla Guadalupi & Benjamín Oteíza, 2025. "The Effects of Intervening the Supply Side of Fraudulent Sick Leaves Market in Chile," Working Papers 2026-50, Becker Friedman Institute for Research In Economics.
    • Handle: RePEc:bfi:wpaper:2026-50
    as

    Download full text from publisher

    File URL: https://repec.bfi.uchicago.edu/RePEc/pdfs/BFI_WP_2026-50.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Janet M. Currie & W. Bentley MacLeod, 2020. "Understanding Doctor Decision Making: The Case of Depression Treatment," Econometrica, Econometric Society, vol. 88(3), pages 847-878, May.
    2. Janet M. Currie & W. Bentley MacLeod, 2018. "Understanding Doctor Decision Making: The Case of Depression," NBER Working Papers 24955, National Bureau of Economic Research, Inc.
    3. David Cutler & Jonathan S. Skinner & Ariel Dora Stern & David Wennberg, 2019. "Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending," American Economic Journal: Economic Policy, American Economic Association, vol. 11(1), pages 192-221, February.
    4. Jonathan T. Kolstad, 2013. "Information and Quality When Motivation Is Intrinsic: Evidence from Surgeon Report Cards," American Economic Review, American Economic Association, vol. 103(7), pages 2875-2910, December.
    5. Pablo A. Celhay & Paul J. Gertler & Paula Giovagnoli & Christel Vermeersch, 2019. "Long-Run Effects of Temporary Incentives on Medical Care Productivity," American Economic Journal: Applied Economics, American Economic Association, vol. 11(3), pages 92-127, July.
    6. Kirill Borusyak & Peter Hull, 2023. "Nonrandom Exposure to Exogenous Shocks," Econometrica, Econometric Society, vol. 91(6), pages 2155-2185, November.
    7. Paul Gertler & Ada Kwan, 2024. "The Essential Role of Altruism in Medical Decision Making," NBER Working Papers 32151, National Bureau of Economic Research, Inc.
    8. Jonathan T. Kolstad, 2013. "Information and Quality when Motivation is Intrinsic: Evidence from Surgeon Report Cards," NBER Working Papers 18804, National Bureau of Economic Research, Inc.
    9. Martin Gaynor & James B. Rebitzer & Lowell J. Taylor, 2004. "Physician Incentives in Health Maintenance Organizations," Journal of Political Economy, University of Chicago Press, vol. 112(4), pages 915-931, August.
    10. Ho, Daniel E. & Imai, Kosuke & King, Gary & Stuart, Elizabeth A., 2007. "Matching as Nonparametric Preprocessing for Reducing Model Dependence in Parametric Causal Inference," Political Analysis, Cambridge University Press, vol. 15(3), pages 199-236, July.
    11. Jeffrey Clemens & Joshua D. Gottlieb, 2014. "Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?," American Economic Review, American Economic Association, vol. 104(4), pages 1320-1349, April.
    12. Stefan Pichler & Katherine Wen & Nicolas R. Ziebarth, 2021. "Positive Health Externalities of Mandating Paid Sick Leave," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 40(3), pages 715-743, June.
    13. Catherine Hausman & David S. Rapson, 2018. "Regression Discontinuity in Time: Considerations for Empirical Applications," Annual Review of Resource Economics, Annual Reviews, vol. 10(1), pages 533-552, October.
    14. Diane Alexander & Molly Schnell, 2024. "The Impacts of Physician Payments on Patient Access, Use, and Health," American Economic Journal: Applied Economics, American Economic Association, vol. 16(3), pages 142-177, July.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Pablo A. Celhay & Nicolás Figueroa & Carla Guadalupi & Benjamín Oteíza, 2026. "Provider and Worker Responses to Supply-Side Audits in Social Insurance," Working Papers 2026-134, Becker Friedman Institute for Research In Economics.
    2. Attema, Arthur E. & Galizzi, Matteo M. & Groß, Mona & Hennig-Schmidt, Heike & Karay, Yassin & L’Haridon, Olivier & Wiesen, Daniel, 2023. "The formation of physician altruism," Journal of Health Economics, Elsevier, vol. 87(C).
    3. Avdic, Daniel & von Hinke, Stephanie & Lagerqvist, Bo & Propper, Carol & Vikström, Johan, 2024. "Do responses to news matter? Evidence from interventional cardiology," Journal of Health Economics, Elsevier, vol. 94(C).
    4. Michael Geruso & Timothy Layton, 2020. "Upcoding: Evidence from Medicare on Squishy Risk Adjustment," Journal of Political Economy, University of Chicago Press, vol. 128(3), pages 984-1026.
    5. Jeffrey Clemens & Jonathan M. Leganza & Alex Masucci, 2026. "Plugging gaps in payment systems: Evidence from the take‐up of new Medicare billing codes," Contemporary Economic Policy, Western Economic Association International, vol. 44(1), pages 105-130, January.
    6. 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.
    7. Jeannette Brosig-Koch & Mona Groß & Heike Hennig-Schmidt & Nadja Kairies-Schwarz & Daniel Wiesen, 2025. "Physicians’ incentives, patients’ characteristics, and quality of care: a systematic experimental comparison of performance-pay systems," International Journal of Health Economics and Management, Springer, vol. 25(2), pages 217-243, June.
    8. Martin Gaynor & Kate Ho & Robert J. Town, 2015. "The Industrial Organization of Health-Care Markets," Journal of Economic Literature, American Economic Association, vol. 53(2), pages 235-284, June.
    9. Diane Alexander, 2020. "How Do Doctors Respond to Incentives? Unintended Consequences of Paying Doctors to Reduce Costs," Journal of Political Economy, University of Chicago Press, vol. 128(11), pages 4046-4096.
    10. Pablo A. Celhay & Paul J. Gertler & Paula Giovagnoli & Christel Vermeersch, 2019. "Long-Run Effects of Temporary Incentives on Medical Care Productivity," American Economic Journal: Applied Economics, American Economic Association, vol. 11(3), pages 92-127, July.
    11. Barili, Emilia & Bertoli, Paola & Grembi, Veronica, 2021. "Neighborhoods, networks, and delivery methods," Journal of Health Economics, Elsevier, vol. 80(C).
    12. Wu, Bingxiao, 2019. "Physician agency in China: Evidence from a drug-percentage incentive scheme," Journal of Development Economics, Elsevier, vol. 140(C), pages 72-89.
    13. Rudy Douven & Minke Remmerswaal & Tobias Vervliet, 2019. "Treatment responses of mental health care providers after a demand shock," CPB Discussion Paper 404, CPB Netherlands Bureau for Economic Policy Analysis.
    14. Anthony Scott & Peter Sivey, 2022. "Motivation and competition in health care," Health Economics, John Wiley & Sons, Ltd., vol. 31(8), pages 1695-1712, August.
    15. Bauhoff,Sebastian Peter Alexander & Kandpal,Eeshani, 2021. "Information, Loss Framing, and Spillovers in Pay-for-Performance Contracts," Policy Research Working Paper Series 9687, The World Bank.
    16. Müller, Tobias & Schmid, Christian & Gerfin, Michael, 2023. "Rents for Pills: Financial incentives and physician behavior," Journal of Health Economics, Elsevier, vol. 87(C).
    17. Manasvini Singh & Jacob Zureich, 2025. "Do Physicians Improve More from Positive or Negative Feedback?," Management Science, INFORMS, vol. 71(5), pages 4198-4222, May.
    18. Nathaniel G. Hilger, 2016. "Why Don't People Trust Experts?," Journal of Law and Economics, University of Chicago Press, vol. 59(2), pages 293-311.
    19. Brosig-Koch, Jeannette & Groß, Mona & Hennig-Schmidt, Heike & Kairies-Schwarz, Nadja & Wiesen, Daniel, 2021. "Physicians' incentives, patients' characteristics, and quality of care: A systematic experimental comparison of fee-for-service, capitation, and pay for performance," Ruhr Economic Papers 923, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    20. Laura Grigolon & Laura Lasio, 2023. "Biased Beliefs and Stigma as Barriers to Treatment and Innovation Adoption," CRC TR 224 Discussion Paper Series crctr224_2023_277v2, University of Bonn and University of Mannheim, Germany.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:bfi:wpaper:2026-50. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Toni Shears The email address of this maintainer does not seem to be valid anymore. Please ask Toni Shears to update the entry or send us the correct address (email available below). General contact details of provider: https://edirc.repec.org/data/mfichus.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.