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

Andrés Ignacio Vecino Ortiz (andres.vecino@gmail.com), David Bardey and Ramón Castano-Yepes

No 5904, Documentos de Trabajo from Universidad del Rosario

Abstract: 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.

Keywords: Small-area variation; health care; procedure of delivery; multilevel analysis. (search for similar items in EconPapers)
JEL-codes: I10 I11 I18 (search for similar items in EconPapers)
Pages: 23
Date: 2009-10-04
New Economics Papers: this item is included in nep-hea and nep-ias
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Persistent link: https://EconPapers.repec.org/RePEc:col:000092:005904

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