Documentos de trabajo DE - ES Lan Gaiak

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Browsing Documentos de trabajo DE - ES Lan Gaiak by Author "Arrieta, Alejandro"

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    Cost sharing and hospitalizations for ambulatory care sensitive conditions
    (2012) Arrieta, Alejandro; García Prado, Ariadna; Economía; Ekonomia
    In this paper, we study the effect of ambulatory and hospital coinsurance rates on HACSC among individuals with private insurance in Chile. During the last decade, Chile´s private health sector has experienced a dramatic increase in its hospitalization rates, growing at four times the rate of ambulatory visits (see graph 1). Such evolution has raised concern among policy makers, interested in promoting more preventive services, and a major use of ambulatory care. The growth on the prevalence of chronic diseases has also set up the alarm. A burden disease study made in 2007 shows that 84% of the total diseases in the country were non-communicable diseases (Universidad Católica de Chile, 2008). The 2003 National Health Survey showed that only a small fraction of those affected by a chronic disease had their condition under control (Bitrán et al, 2010). In this context, coinsurance can be a valuable tool for dealing with cost escalating problems in the health system while, at the same time, promoting more ambulatory visits and preventive services and less HCSC.
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    Enrolling the self-employed in mandatory health insurance in Colombia: are we missing other factors?
    (2012) Arrieta, Alejandro; García Prado, Ariadna; Panopoulou, Giota; Economía; Ekonomia
    We assess the impact that Colombia’s 1993 health sector reform had on the enrollment of self-employed workers in mandatory social health insurance scheme, with a especial focus on the independent contractors. This group grew dramatically in the form of workers cooperatives between 1993 and 2003, becoming a source of self-employed evasion and a way to disguised employment. We use two national-level Living Standards Measurement Surveys conducted in Colombia in 1997 and 2003, and follow a methodology that corrects for sample selection, decomposing health insurance coverage variation into changes attributed to the reform and to the characteristics of independent contractors. We find that: (i) Between 1997 and 2003, enrollment increased in 28 percentage points reaching an insurance rate of 62%, still below the reform goal of 80%, (ii) enrollment of independent contractors in 1997 was only 35% (compared to 50%) after adjusting by the selection bias due to disguised employment, (ii) the new legislation and stringent monitoring implemented in 2003 to cope with evasion seem to be effective since the sample selection due to disguised employment was not statistically significant in 2003. Addressing the interaction of the labor market with the health reform, as well as, accounting for the heterogeneity within the self-employed group are the main contributions of this paper to the literature on health insurance reforms in developing countries.
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    PublicationOpen Access
    Non-elective cesarean sections in public hospitals: hospital capacity constraints and doctor´s incentives
    (2012) Arrieta, Alejandro; García Prado, Ariadna; Economía; Ekonomia
    Using administrative records of births from the Perinatal Surveillance System of the Social Security System (ESSALUD) in Peru, we test whether high admissions of pregnant women affected unplanned cesarean section rates in the ESSALUD public hospitals during the period 2005-2006. To this purpose, we present a basic theoretical model that considers not only physician preference for leisure but also the effect of hospital capacity constraints. Based on inferences of this model, we find that physician demand for leisure increases the probability of a c-section in the smallest hospitals, while hospital constraints set a limit on the number of cesarean sections that can be performed. We discuss the policy implications of our findings and the policies implemented in ESSALUD to monitor the quality of obstetric services and avoid unnecessary or unjustified c-sections.