Three essays on health economics and policy interventions

This thesis examines the health and economic impacts of policy interventions in Colombia through three distinct studies. It explores critical policy interventions in the Colombian healthcare system, focusing on the implications for health outcomes, cost management, and risk adjustment mechanisms. Each paper addresses a different dimension of the healthcare landscape, analyzing the complex interplay between health policy, economic incentives, and institutional design. The first paper investigates the impact of the end of armed conflict on health at birth, leveraging the 2016 ceasefire between the Colombian government and FARC guerrillas as a natural experiment. Using a difference-in-differences approach, the study finds nuanced effects on birth outcomes. The conflict's end resulted in a rise in very low birth weights, likely due to the increased survival of weaker newborns, while reduced maternal stress improved the likelihood of higher birth weights. These effects were most pronounced in municipalities where post-conflict rebuilding efforts were concentrated, underscoring the significance of institutional capacity in shaping health outcomes. Additionally, the study reveals an increase in the likelihood of births being attended by medical personnel, suggesting improved access to healthcare services following the resolution of the conflict. The second paper shifts focus to the economic side of healthcare, examining the transition from a retrospective to a prospective drug reimbursement scheme for insurers. Under the retrospective system, insurers were reimbursed for the actual costs of drugs, but the uncertainty around timing and amounts led to inefficiencies. The study finds that the shift to a prospective payment scheme—where insurers receive a fixed amount per enrollee—had mixed effects. While it increased the quantity of low-sales drugs and reduced prices, it also prompted strategic responses from insurers, particularly in managing drugs still under the retrospective system. These strategic behaviors, which include increasing sales of non-prospective drugs, highlight the complexities of cost control under different reimbursement structures and suggest that the design of payment schemes can significantly influence healthcare spending patterns. The third paper addresses the challenge of risk selection in health insurance markets, where inaccurate risk adjustment formulas can lead to unfair compensation for insurers and reduced access to care for high-risk groups. This paper proposes a novel econometric methodology for selecting variables in risk adjustment formulas, balancing the need for accurate risk prediction with the risks of overcompensation and the potential for strategic behaviors like upcoding. By analyzing a rich dataset from Colombia, the study identifies an optimal set of variables regulators can use to fine-tune risk adjustment models. This approach provides a framework for minimizing risk selection while maintaining cost control.

• Autores: Arias Camacho, Camilo Antonio
• Tipo de recurso: Doctoral thesis
• Fecha de publicación: 2024
• Institución: Universidad de los Andes
• Repositorio: Séneca: repositorio Uniandes
• Idioma: eng
• OAI Identifier: oai:repositorio.uniandes.edu.co:1992/75655
• Acceso en línea: https://hdl.handle.net/1992/75655
• Palabra clave: Economía de la salud; Salud al nacer; Ajuste de riesgo; Inclusiones UPC; Economía
• Rights: openAccess
• License: Attribution-NonCommercial-NoDerivatives 4.0 International