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Does Contracting-Out Primary Care Services Work? The Case of Rural Guatemala

  • Julian Cristia


  • William Evans
  • Beomsoo Kim

This paper estimates the impact of a large-scale contracting-out program in Guatemala, using two waves of living standard measurement surveys which collected data before and after the expansion of the program and exploiting variation in the timing of the program to estimate treatment effects. Results indicate large program impacts on immunization rates for children and prenatal care provider choices. The program increases substantially the role of physician and nurses as prenatal care providers at the expense of traditional midwives. There is no evidence of effects in family planning outcomes. Taken together these results suggest a potential effective role of contracting-out in the provision of health care.

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Paper provided by Inter-American Development Bank, Research Department in its series Research Department Publications with number 4728.

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Date of creation: Nov 2011
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Handle: RePEc:idb:wpaper:4728
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  1. Filmer, Deon & Hammer, Jeffrey S & Pritchett, Lant H, 2000. "Weak Links in the Chain: A Diagnosis of Health Policy in Poor Countries," World Bank Research Observer, World Bank Group, vol. 15(2), pages 199-224, August.
  2. Gary S. Becker & Tomas J. Philipson & Rodrigo R. Soares, 2005. "The Quantity and Quality of Life and the Evolution of World Inequality," American Economic Review, American Economic Association, vol. 95(1), pages 277-291, March.
  3. Basinga, Paulin & Gertler, Paul J. & Binagwaho, Agnes & Soucat, Agnes L.B. & Sturdy, Jennifer R. & Vermeersch, Christel M.J., 2010. "Paying primary health care centers for performance in Rwanda," Policy Research Working Paper Series 5190, The World Bank.
  4. Filmer, Deon & Pritchett, Lant, 1999. "The impact of public spending on health: does money matter?," Social Science & Medicine, Elsevier, vol. 49(10), pages 1309-1323, November.
  5. repec:tpr:qjecon:v:119:y:2004:i:1:p:249-275 is not listed on IDEAS
  6. Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2002. "How Much Should We Trust Differences-in-Differences Estimates?," NBER Working Papers 8841, National Bureau of Economic Research, Inc.
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