Acceso Abierto

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

dc.creatorVecino Ortiz, Andrés Ignacio
dc.creatorBardey, David
dc.creatorCastaño Yepez, Ramón Abel
dc.description.abstractIn 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.eng
dc.format.extent24 páginasspa
dc.format.mediumRecurso electrónicospa
dc.identifier.citationVecino Ortiz, A. I., Bardey, D., & Castaño Yepes, R. A. (2009). Small-area variation in health care affecting the choice of cesarean delivery: the case of a Colombian health insurer. Bogotá: Universidad del Rosario, Facultad de Economía.
dc.identifier.editorialUniversidad del Rosario, Facultad de Economíaspa
dc.publisherUniversidad del Rosariospa
dc.publisher.departmentFacultad de Economíaspa
dc.relation.citationIssueNo. 73
dc.relation.citationTitleSerie Documentos de trabajo. Economía
dc.relation.ispartofSerie Documentos de trabajo ; No. 73spa
dc.rights.accesoAbierto (Texto completo)spa
dc.rights.ccAtribución-NoComercial-SinDerivadas 2.5 Colombiaspa
dc.source.bibliographicCitationAlthabe et al. 2006. Caesarean section rates and maternal and neonatal mortality in low-, medium- and high-income countries: an ecological study. Birth 33 (4):270-277.
dc.source.bibliographicCitationBardey D, Lesur, R. (2006) Optimal regulation of health system with induced demand and “expost” moral hazard. Annales d'Economie et de Statistique 83-84 : 279-293
dc.source.bibliographicCitationBech M, Lauridsen J. 2007. Dynamic Patterns and Small-Area Variation in Hospital Admissions. iHEA 2007 6th World Congress: Explorations in Health Economics Paper. Available at SSRN: http://ssrn.com/abstract=992285
dc.source.bibliographicCitationBelizán JM, Althabe F, Barros FC, Alexander S. 1999. Rates and implications of caesarean sections in Latin America: ecological study. British Medical Journal 319(7222): 1397-1402.
dc.source.bibliographicCitationBlomqvist A. 1991. The doctor as double agent: information asymmetry, health insurance, and medical care. Journal of Health Economics 10(4): 411-432.
dc.source.bibliographicCitationBlomqvist S, Christiansen V. 2004. Taxation and heterogeneous preferences. Working Paper # 1244. Center for Economic Studies and Ifo Institute for Economics Research: Oslo, Norway. Available at URL: http://SSRN.com/abstract=580543
dc.source.bibliographicCitationCastano R, Zambrano A. 2006. Biased selection within the social health insurance market in Colombia. Health Policy 79(2-3): 313-324.
dc.source.bibliographicCitationChhabra P, Kumar AK, Tupil KA. 2006. Obstetric and neonatal outcomes in women who live in an urban resettlement area of Delhi, India: A cohort study. Journal of Obstetrics and Gynaecology Research 32(6): 567–573.
dc.source.bibliographicCitationDavis P, Gribben B, Scott A, Lay-Yee R. 2000. The “supply hypothesis” and medical practice variation in primary care: Testing economic and clinical models of inter-practitioner variation. Social Science & Medicine 50(3): 407–418.
dc.source.bibliographicCitationEpstein A, Nicholson, S. 2009. The formation and evolution of physician treatment styles: an application to cesarean sections. Journal of Health Economics. In press: doi:10.1016/j.jhealeco.2009.08.003
dc.source.bibliographicCitationFabri RH, Murta EFC. 2002. Socioeconomic factors and cesarean section rates. International Journal of Gynecology & Obstetrics 76(1): 87-88
dc.source.bibliographicCitationGrant D. 2009. Physician financial incentives and cesarean delivery: New conclusions from the healthcare cost and utilization project. Journal of Health Economics 28(1): 244-250.
dc.source.bibliographicCitation. Grytten and Sørensen. 2003. Practice variation and physician-specific effects. Journal of Health Economics. 22(3): 403-418.
dc.source.bibliographicCitationFuchs VR. 1978. The supply of surgeons and the demand for operations. Journal of Human Resources, 13 (Suppl: National Bureau of Economic Research conference on the Economics of Physician and Patient Behaviour, 1978): 35–56.
dc.source.bibliographicCitationHsu KH, Liao P, Hwang CJ. 2008. Factors affecting Taiwanese women's choice of cesarean section. Social Science and Medicine 66(1): 201-209.
dc.source.bibliographicCitationIams JD, Chawla A. 1984. Patient costs in the prevention and treatment of post-cesarean section infection. American Journal of Obstetrics and Gynaecology 149(4): 363-366.
dc.source.bibliographicCitationJaramillo H, Latorre C, Albán MC, Lopera C. 2008. El Hospital como organización de conocimiento y espacio de investigación y formación. Los recursos humanos en salud y su tránsito a comunidades científicas: el caso de la investigación clínica en Colombia. Centro Editorial Rosarista: Bogotá, Colombia.
dc.source.bibliographicCitationLabelle R, Stoddart G, Rice T. 1994. a re-examination of the meaning and importance of supplier-induced demand. Journal of Health Economics 13 (3): 347-368
dc.source.bibliographicCitationMacDorman MF, Declercq E, Menacker F, Malloy MH. 2003. Infant and neonatal mortality for primary cesarean and vaginal births to women with ‘‘no indicated risk,’’ United States, 1998– 2001 birth cohorts. Birth: Issues in Perinatal Care 33(3): 175-182.
dc.source.bibliographicCitationMc Pherson K, Wennberg JE, Hoving OB, Clifford P. 1982. Small area variations in the use of common surgical procedures. New England of Journal of Medicine 307(21): 1310-1314.
dc.source.bibliographicCitationNewhouse JP, Phelps CE. 1976. New Estimates of Price and Income Elasticities for Medical Care Services. In The Impact of Health Insurance on the Health Services Sector, Rosett R (ed). National Bureau of Economic Research: New York.
dc.source.bibliographicCitationPhelps CE, Mooney C. 1993. Variation in the use of medical practice use: causes and consequences. In Competitive Approaches to Health Care Reform, Arnould RJ, Rich RF, White WD (eds). Urban Institute Press: Washington, D.C.
dc.source.bibliographicCitationPhelps CE, Mooney C, Mushlin AI, Handy B, Perkins N. 1994. Doctors have styles - And they matter! Working Paper # 2057. University of Rochester Libraries: Rochester, NY. Available at URL: http://hdl.handle.net/1802/2057
dc.source.bibliographicCitationPhelps CE, Newhouse JP. 1974. Coinsurance and the demand for medical care. Review of economics and statistics 56(3): 334-342.
dc.source.bibliographicCitationRabe-Hesketh S, Skrondal A. 2008. Multilevel and longitudinal modeling using Stata. Stata Press: College Station, TX.
dc.source.bibliographicCitationRuiz A, Gómez C, Londoño D. 2001. Investigación clínica: Epidemiología clínica aplicada. Centro Editorial Javeriano: Bogotá D.C., Colombia
dc.source.bibliographicCitationStano M. 1993. Evaluating the policy role of the small area variations and physician practice style hypotheses. Health Policy 24 (1): 9–17.
dc.source.bibliographicCitationTita ATN et al. 2009. Timing of elective repeat cesarean delivery at term and neonatal outcomes. New England Journal of Medicine 360(2): 111-120.
dc.source.bibliographicCitationTollånes MC, Rasmussen S, Irgens LM. 2008. Cesarean among relatives. International Journal of Epidemiology 37(6): 1341-1348
dc.source.bibliographicCitationTschudin S, et al. 2009. Pregnant women's perception of cesarean section on demand. Journal of Perinatal Medicine 37(3): 251–256.
dc.source.bibliographicCitationVecino-Ortiz AI. 2008. Determinants of demand for antenatal care in Colombia. Health Policy 86(2-3): 363-372.
dc.source.bibliographicCitationVillar J et al. 2006. Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet 367 (9525):1819-1829
dc.source.bibliographicCitationVimercati A et al. 2000. Choice of cesarean section and perception of legal pressure. Journal of Perinatal Medicine 28(2): 111-117.
dc.source.bibliographicCitationWennberg J, Gittelsohn A. 1973. Small area variations in health care delivery. Science 182(117): 1102–1108.
dc.source.bibliographicCitationWorld Health Organization. 1985. Appropriate technology for birth. Lancet 2(8452): 436–437.
dc.source.instnameinstname:Universidad del Rosariospa
dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subject.ddcProblemas & servicios de bienestar social
dc.subject.keywordSmall-area variationeng
dc.subject.keywordHealth careeng
dc.subject.keywordProcedure of deliveryeng
dc.subject.keywordMultilevel analysiseng
dc.subject.lembAtención médica::Utilizaciónspa
dc.subject.lembAnálisis multivariantespa
dc.subject.lembAnálisis de varianzaspa
dc.titleSmall-area variation in health care affecting the choice of cesarean delivery: the case of a Colombian health insurerspa
dc.type.spaDocumento de trabajospa
Bloque original
Mostrando1 - 2 de 2
289 B
Hypertext Markup Language
Documento Principal
166.17 KB
Adobe Portable Document Format