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Evaluating The Impact Of Health Care Reform In Colombia: From Theory To Practice

Author

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  • Alejandro Gaviria

    ()

  • Carlos Medina

    ()

  • 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.

Suggested Citation

  • Alejandro Gaviria & Carlos Medina & Carolina Mejía, 2006. "Evaluating The Impact Of Health Care Reform In Colombia: From Theory To Practice," DOCUMENTOS CEDE 002647, UNIVERSIDAD DE LOS ANDES-CEDE.
  • Handle: RePEc:col:000089:002647
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    File URL: http://economia.uniandes.edu.co/publicaciones/d2006-06.pdf
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    References listed on IDEAS

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    Full references (including those not matched with items on IDEAS)

    Citations

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    Cited by:

    1. Sosa-Rubí, Sandra G. & Galárraga, Omar & Harris, Jeffrey E., 2009. "Heterogeneous impact of the "Seguro Popular" program on the utilization of obstetrical services in Mexico, 2001-2006: A multinomial probit model with a discrete endogenous variable," Journal of Health Economics, Elsevier, vol. 28(1), pages 20-34, January.
    2. Adam Wagstaff, 2010. "Social health insurance reexamined," Health Economics, John Wiley & Sons, Ltd., vol. 19(5), pages 503-517.
    3. World Bank, 2009. "Colombia - Decentralization : Options and Incentives for Efficiency - Sector Annexes," World Bank Other Operational Studies 3097, The World Bank.
    4. World Bank, 2009. "Colombia - Decentralization : Options and Incentives for Efficiency - Main Report," World Bank Other Operational Studies 3096, The World Bank.
    5. Andrés Ramírez Hassan & Johnatan Cardona Jimenez & Ramiro Cadavid Montoya, 2011. "The impact of subsidized health insurance on the poor in Colombia: Evaluating the case of Medellin," DOCUMENTOS DE TRABAJO CIEF 010602, UNIVERSIDAD EAFIT.
    6. Abadia, Cesar Ernesto & Oviedo, Diana G., 2009. "Bureaucratic Itineraries in Colombia. A theoretical and methodological tool to assess managed-care health care systems," Social Science & Medicine, Elsevier, pages 1153-1160.
    7. Wagstaff, Adam, 2007. "Health insurance for the poor : initial impacts of Vietnam's health care fund for the poor," Policy Research Working Paper Series 4134, The World Bank.
    8. Wagstaff, Adam & Lindelow, Magnus & Jun, Gao & Ling, Xu & Juncheng, Qian, 2009. "Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme," Journal of Health Economics, Elsevier, vol. 28(1), pages 1-19, January.
    9. Víctor Mauricio Castañeda Rodríguez, 2014. "El gasto social como factor que favorece una mayor dependencia del IVA. Un análisis para el caso colombiano," REVISTA ECOS DE ECONOMÍA, UNIVERSIDAD EAFIT, June.

    More about this item

    Keywords

    demand subsidies; targeted social services; instrumental variables;

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs

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