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

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.

The international economic crisis and the colombian economy

The purpose of this research is to provide an approximation to the likely effects of the crisis on the Colombian economy and to the effectiveness of policy response. For this, the most relevant transmission channels and policy measures are simulated in the setting of a static computable general equilibrium model (CGE). The results obtained are interesting in their own right and are in line with what could be expected given the information available on the behavior of the Colombian economy. Furthermore, they call into question the effectiveness of governmental intervention as judged by its intended countercyclical effects.

Can SMS Technology Improve Low Take-up of Social Benefits?

Low take up of stigma-free social benefits is often blamed on information asymmetries or administrative barriers. There is limited evidence on which of these potential channels is more salient in which contexts. We designed and implemented a randomized controlled trial to assess the extent to which informational barriers are responsible for the prevalent low take-up of government benefits among Colombian conflict-driven internal refugees. We provide timely information on benefits eligibility via SMS to a random half of the displaced household that migrated to Bogot´a over a 6-month period. We show that improving information increases benefits’ take up. However, the effect is small and only true for certain type of benefits. Hence, consistent with previous experimental literature, the availability of timely information explains only part of the low-take up rates and the role of administrative barriers and bureaucratic processes should be tackled to increase the well-being of internal refugees in Colombia.

Cartoons and economics: general analysis based on colombian economic cartoons

May cartoons be considered as a viable and credible source for the study of economics? There is hardly any research on the subject, even though there is a quite significant amount of cartoons with economic content. This suggests that economics (and economists) have not paid enough attention and do not incorporate in their analysis a relevant primary source. The present paper aims to explore the value of using cartoons as a complementary primary source in economic analysis. We present a way of analyzing economic history through cartoons; first, reviewing cartoons which describe particular historical circumstances and second, examining cartoons that represent generic economic situations and are not necessarily linked to a historical period. We choose 17 cartoons, from different cartoonist, especially Colombian cartoonists that may give us an idea of economic matters and economic history.

Comentarios sobre la propuesta de reforma a la estructura arancelaria colombiana

En este estudio se evalúan los efectos estáticos de una reciente propuesta de reforma a la actual estructura arancelaria aplicada por Colombia. La propuesta, realizada por el gobierno, estaba dirigida a racionalizar dicha estructura y a propiciar un mejoramiento de la productividad de la industria, pero fue desechada en vista de la oposición del sector privado a la misma. La evaluación se hace mediante un modelo de equilibrio general computable multipaís. Sus resultados indican que la no implementación de la propuesta implica renunciar a las ganancias de bienestar esperables de una combinación de ésta y de la implementación de los acuerdos que hacen parte de la agenda comercial del país.

A firm-level analysis of ICT adoption in an emerging economy: evidence from the colombian manufacturing industries

This study examines ICT adoption among 3,759 Colombian manufacturing firms, and attempts to identify the factors that are conducive to the adoption and usage of ICT at the firm level. Our major findings are (i) that the adoption of a given information and communication technology is better facilitated when a firm is relatively large, has large human capital, engages in more innovative activities, and when a firm’s organizational structure is better aligned with the given technology; (ii) that positive associations between the key determinants and ICT adoptions are more pronounced for small and medium-sized firms than for large ones, and (iii) that information spillovers within industries is also a determinant of ICT adoptions by the firms.

Do Colombian students underestimate higher education returns?

We analyze the determinants of subjective returns of higher education in Colombia. The information on expectations has been collected in categories, motivating the use of interval regression and an ordered probit approaches for modeling the relationship between beliefs and measures of ability, conditioning on individual, school and regional covariates. The results suggest that there are considerable differences in the size of the expected returns according to some population groups and a strong dominance of college against technical education. Gender gaps disappear in college education but it is found that girls tend to believe that professional wages are more concentrated into higher income categories than boys. Finally, it seems that Colombian students overestimate the pecuniary returns to education.

Echoes of the crises in Spain and US in the Colombian labor market : a differences-in-differences approach

This paper presents evidence of the effect of the recent phases of the business cycle in Spain and United States, proxied by their respective unemployment rates, on the labor market of Colombian cities with high migration tradition. These countries are the main destination for labor Colombian migrants. Using information from the household survey between 2006 and 2011 for urban areas in Colombia and a differences-in-differences approach we find that unemployment rates of those countries negatively affect the probability and the amount of remittances received by Colombian households living in areas with high and moderate migration tradition. At a second stage we provide evidence that unemployment rates of those countries positively affect the labor force participation decisions in Colombian regions with the highest migration tradition.

A Network model of systemic risk : identifying the sources of dependence across institutions

We design a financial network model that explicitly incorporates linkages across institutions through a direct contagion channel, as well as an indirect common exposure channel. In particular, common exposure is setup so as to link the financial to the real sector. The model is calibrated to balance sheet data on the colombian financial sector. Results indicate that commercial banks are the most systemically important financial institutions in the system. Whereas government owned institutions are the most vulnerable institutions in the system.

Health insurance as a strategy for access : Streamlined facts of the Colombian Health Care Reform

La reforma colombiana al sistema de salud (Ley 100 de 1993) estableció, como estrategia para facilitar el acceso, la universalidad de un seguro de salud que se adquiere mediante la cotización en el régimen contributivo o mediante la afiliación gratuita al régimen subsidiado, con la meta de cubrir a toda la población con un plan de beneficios único que comprende servicios de todos los niveles de atención. En el documento se analizan los principales hechos estilizados de la reforma en cuanto a cobertura del seguro y acceso y, mediante modelos logit, se estiman los determinantes de la afiliación y del acceso, con datos de las encuestas de calidad de vida de 1997 y 2003. Se destaca que la cobertura pasó del 20% de la población en 1993 al 60% en 2004, aunque parece imposible alcanzar la universalidad; la estructura y evolución de la cobertura muestran que los dos regímenes son complementarios, de modo que mientras el contributivo tiene mayor presencia en las ciudades y entre la población con empleo formal, el subsidiado tiene mayor peso entre la población rural y con bajos niveles de ingresos; por otra parte, el seguro tiene ventajas para la población subsidiada, con una mayor probabilidad de utilización de servicios, aunque el plan es inferior al del contributivo y existen barreras para el acceso.

Biased selection within the social health insurance market in Colombia

Las regulaciones como primaje comunitario, paquetes estandarizados y afiliación abierta, orientadas a reducir el impacto de las fallas en los mercados de seguros, tienen un efecto limitado puesto que abren espacio a la selección sesgada. A partir de 1993, el sistema de seguridad social en salud en Colombia fue reformado hacia un enfoque de mercado con la expectativa de mejorar el desempeño de los monopolios preexistentes exponiéndolos a la competencia de nuevos entrantes. La hipótesis que se maneja en el trabajo es que las fallas de mercado pueden llevar a selección sesgada favoreciendo a los nuevos entrantes. Se analizaron dos encuestas de hogares utilizando el estado de salud auto reportado y la presencia de enfermedad crónica como indicadores prospectivos del riesgo de los afiliados. Se encuentra que hay selección sesgada, llevando a selección adversa entre los aseguradores preexistentes, y a selección favorable entre los nuevos entrantes. Este patrón se observa en 1997 y se incrementa en el 2003. Aunque las entidades preexistentes son entidades públicas, y su tamaño disminuyó sustancialmente entre estos años, se analizan sus implicaciones fiscales en términos de financiación adicional por parte del gobierno.

An approximation to the standard of living index: the Colombian case

El documento busca mostrar las principales propiedades de un indicador de estándar de vida dentro del enfoque teórico de Amartya Sen. Establecemos un puente entre conceptos tales como: bienestar económico, bienestar, logro de agencia y estándar de vida. La metodología del Optimal scaling fue usada para probar las propiedades de Monotonicidad, No independencia de alternativas irrelevantes, Concavidad, informatividad y sustituibilidad.

The determinants of the health status in a developing country: results from the Colombian case

El artículo busca encontrar evidencia empírica de los determinantes de la salud, como una medición de capital salud en un país en desarrollo después de una profunda reforma en el sector salud. Siguiendo el modelo de Grossman (1972) y tomando factores institucionales, además de las variables individuales y socioeconómicas. Se usaron las encuestas de 1997 y 2000 donde se responde subjetivamente sobre el estado de salud y tipo de afiliación al sistema de salud. El proceso de estimación usado es un probit ordenado. Los resultados muestran una importante conexión entre las variables individuales, institucionales y socioeconómicas con el estado de salud. El efecto de tipo de acceso al sistema de salud presiona las inequidades en salud.