IDEAS home Printed from https://ideas.repec.org/p/nbr/nberwo/33738.html

The Importance of Preventive Medical Care for Managing Chronic Disease

Author

Listed:
  • Claire Boone
  • Pablo A. Celhay
  • Paul Gertler
  • Tadeja Gracner

Abstract

We study how preventive medical care use affects health behaviors and outcomes for patients with chronic diseases. Leveraging variation induced by a national appointment reminder program, rolled out across 315 public primary care clinics in Chile, we use an instrumental variables approach with patient-level administrative data from over 300,000 patients with type 2 diabetes or hypertension. We find that increased preventive visits lead to more screening tests and large increases in medication adherence. Preventive care also leads to earlier detection and treatment of cardiovascular complications; we document an increase in cardiovascular hospitalizations but a reduction in in-hospital mortality.

Suggested Citation

  • Claire Boone & Pablo A. Celhay & Paul Gertler & Tadeja Gracner, 2025. "The Importance of Preventive Medical Care for Managing Chronic Disease," NBER Working Papers 33738, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:33738
    Note: AG DEV EH PE
    as

    Download full text from publisher

    File URL: http://www.nber.org/papers/w33738.pdf
    Download Restriction: Access to the full text is generally limited to series subscribers, however if the top level domain of the client browser is in a developing country or transition economy free access is provided. More information about subscriptions and free access is available at http://www.nber.org/wwphelp.html. Free access is also available to older working papers.
    ---><---

    As the access to this document is restricted, you may want to

    for a different version of it.

    References listed on IDEAS

    as
    1. Heidi Allen & Katherine Baicker, 2021. "The Effect of Medicaid on Care and Outcomes for Chronic Conditions: Evidence from the Oregon Health Insurance Experiment," NBER Working Papers 29373, National Bureau of Economic Research, Inc.
    2. Aviva Aron-Dine & Liran Einav & Amy Finkelstein, 2013. "The RAND Health Insurance Experiment, Three Decades Later," Journal of Economic Perspectives, American Economic Association, vol. 27(1), pages 197-222, Winter.
    3. Emily Oster, 2018. "Diabetes and Diet: Purchasing Behavior Change in Response to Health Information," American Economic Journal: Applied Economics, American Economic Association, vol. 10(4), pages 308-348, October.
    4. Stefano DellaVigna, 2009. "Psychology and Economics: Evidence from the Field," Journal of Economic Literature, American Economic Association, vol. 47(2), pages 315-372, June.
    5. David Card & Carlos Dobkin & Nicole Maestas, 2008. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare," American Economic Review, American Economic Association, vol. 98(5), pages 2242-2258, December.
    6. Alyce Adams & Raymond Kluender & Neale Mahoney & Jinglin Wang & Francis Wong & Wesley Yin, 2022. "The Impact of Financial Assistance Programs on Health Care Utilization: Evidence from Kaiser Permanente," American Economic Review: Insights, American Economic Association, vol. 4(3), pages 389-407, September.
    7. Stefano DellaVigna & Ulrike Malmendier, 2006. "Paying Not to Go to the Gym," American Economic Review, American Economic Association, vol. 96(3), pages 694-719, June.
    8. Amy Finkelstein & Sarah Taubman & Bill Wright & Mira Bernstein & Jonathan Gruber & Joseph P. Newhouse & Heidi Allen & Katherine Baicker, 2012. "The Oregon Health Insurance Experiment: Evidence from the First Year," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 127(3), pages 1057-1106.
    9. repec:oup:qjecon:v:136:y:2021:i:1:p:1-49. is not listed on IDEAS
    10. Sarah Miller & Norman Johnson & Laura R Wherry, 2021. "Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(3), pages 1783-1829.
    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. Claire E. Boone & Pablo A. Celhay & Paul Gertler & Tadeja Gracner, 2023. "Encouraging Preventative Care to Manage Chronic Disease at Scale," NBER Working Papers 31643, National Bureau of Economic Research, Inc.
    2. Shi, Julie & Yang, Wanyu & Yuan, Ye, 2025. "Cover more for less: Targeted drug coverage, chronic disease management, and medical spending," Journal of Development Economics, Elsevier, vol. 172(C).
    3. Feng Huang & Li Gan`, 2017. "The Impacts of China's Urban Employee Basic Medical Insurance on Healthcare Expenditures and Health Outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 26(2), pages 149-163, February.
    4. Calvin Ackley & Abe Dunn & Eli Liebman & Adam Hale Shapiro, 2025. "Are Medicaid and Medicare Patients Treated Equally?," Working Paper Series 2024-14, Federal Reserve Bank of San Francisco.
    5. Kevin Devereux & Mona Balesh Abadi & Farah Omran, 2019. "Correcting for Transitory Effects in RCTs: Application to the RAND Health Insurance Experiment," Working Papers 201910, School of Economics, University College Dublin.
    6. Lin, Lin & Zai, Xianhua, 2022. "The Power of Public Insurance With Limited Benefits: Evidence from China's New Cooperative Medical Scheme," GLO Discussion Paper Series 1180, Global Labor Organization (GLO).
    7. Nicolas R. Ziebarth, 2018. "Social Insurance and Health," Contributions to Economic Analysis, in: Health Econometrics, volume 127, pages 57-84, Emerald Group Publishing Limited.
    8. Klein, Alexander & Crafts, Nicholas, 2023. "Unconditional Convergence in Manufacturing Productivity across U.S. States: What the Long-Run Data Show," CEPR Discussion Papers 18065, C.E.P.R. Discussion Papers.
    9. Chaoran Chen & Zhigang Feng & Jiaying Gu, 2025. "Health, Health Insurance, And Inequality," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 66(1), pages 107-141, February.
    10. Menares, Felipe & Muñoz, Pablo, 2025. "The impact of standardized disease-specific healthcare coverage," Journal of Public Economics, Elsevier, vol. 242(C).
    11. repec:dem:wpaper:wp-2022-025 is not listed on IDEAS
    12. Zhang, Yan & Zhao, Guangchuan & Gu, Hai, 2022. "Investing in health capital: Does medical insurance matter?," Research in International Business and Finance, Elsevier, vol. 61(C).
    13. Nilsson, Anton & Paul, Alexander, 2018. "Patient cost-sharing, socioeconomic status, and children's health care utilization," Journal of Health Economics, Elsevier, vol. 59(C), pages 109-124.
    14. Paolo Nicola Barbieri & Laura Bottazzi & Giuseppe Di Giacomo, 2026. "Debtor Protection and Health Insurance: Evidence From Personal Bankruptcy Reform," CESifo Working Paper Series 12388, CESifo.
    15. De Paola, Maria & Scoppa, Vincenzo, 2015. "Procrastination, academic success and the effectiveness of a remedial program," Journal of Economic Behavior & Organization, Elsevier, vol. 115(C), pages 217-236.
    16. Singh, Nirvikar, 2018. "Financial Inclusion: Concepts, Issues and Policies for India," MPRA Paper 91047, University Library of Munich, Germany.
    17. Steffen Andersen & Cristian Badarinza & Lu Liu & Julie Marx & Tarun Ramadorai, 2022. "Reference Dependence in the Housing Market," American Economic Review, American Economic Association, vol. 112(10), pages 3398-3440, October.
    18. Mengna Luan & Wenjing Shi & Zhigang Tao & Hongjie Yuan, 2023. "When patients have better insurance coverage in China: Provider incentives, costs, and quality of care," Economics of Transition and Institutional Change, John Wiley & Sons, vol. 31(4), pages 1073-1106, October.
    19. Griffith, Rachel & O'Connell, Martin & Smith, Kate & Cherchye, Laurens & De Rock, Bram & Vermeulen, Frederic, 2017. "A new year, a new you? Heterogeneity and self-control in food purchases," CEPR Discussion Papers 12499, C.E.P.R. Discussion Papers.
    20. Samuel Dodini, 2023. "Insurance Subsidies, the Affordable Care Act, and Financial Stability," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 42(1), pages 97-136, January.
    21. Hsing-Wen Han & Hsien-Ming Lien & Tzu-Ting Yang, 2020. "Patient Cost-Sharing and Healthcare Utilization in Early Childhood: Evidence from a Regression Discontinuity Design," American Economic Journal: Economic Policy, American Economic Association, vol. 12(3), pages 238-278, August.

    More about this item

    JEL classification:

    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    NEP fields

    This paper has been announced in the following NEP Reports:

    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:nbr:nberwo:33738. 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: the person in charge (email available below). General contact details of provider: https://edirc.repec.org/data/nberrus.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.