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Small-area variation in health care affecting the choice of cesarean delivery: the case of a colombian health insurer


  • Vecino Ortiz, Andrés Ignacio


  • Bardey, David


  • Castano-Yepes, Ramón


In the midst of health care reform, Colombia has succeeded in increasing health insurance coverage and the quality of health care. In spite of this, efficiency continues to be a matter of concern, and small-area variations in health care are one of the plausible causes of such inefficiencies. In order to understand this issue, we use individual data of all births from a Contributory-Regimen insurer in Colombia. We perform two different specifications of a multilevel logistic regression model. Our results reveal that hospitals account for 20% of variation on the probability of performing cesarean sections. Geographic area only explains 1/3 of the variance attributable to the hospital. Furthermore, some variables from both demand and supply sides are found to be also relevant on the probability of undergoing cesarean sections. This paper contributes to previous research by using a hierarchical model and by defining hospitals as cluster. Moreover, we also include clinical and supply induced demand variables.

Suggested Citation

  • Vecino Ortiz, Andrés Ignacio & Bardey, David & Castano-Yepes, Ramón, 2009. "Small-area variation in health care affecting the choice of cesarean delivery: the case of a colombian health insurer," DOCUMENTOS DE TRABAJO 005904, UNIVERSIDAD DEL ROSARIO.
  • Handle: RePEc:col:000092:005904

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    Small-area variation; health care; procedure of delivery; multilevel analysis.;

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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