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 ord...

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Autores Principales: Vecino Ortiz, Andrés Ignacio, Bardey, David, Castaño Yepez, Ramón Abel
Formato: Documento de trabajo (Working Paper)
Lenguaje:Español (Spanish)
Publicado: Universidad del Rosario 2009
Materias:
Acceso en línea:http://repository.urosario.edu.co/handle/10336/10850
id ir-10336-10850
recordtype dspace
institution EdocUR - Universidad del Rosario
collection DSpace
language Español (Spanish)
topic Problemas & servicios de bienestar social
Hospitales::Utilización
Atención médica::Utilización
Análisis multivariante
Análisis de varianza
Small-area variation
Health care
Procedure of delivery
Multilevel analysis
spellingShingle Problemas & servicios de bienestar social
Hospitales::Utilización
Atención médica::Utilización
Análisis multivariante
Análisis de varianza
Small-area variation
Health care
Procedure of delivery
Multilevel analysis
Vecino Ortiz, Andrés Ignacio
Bardey, David
Castaño Yepez, Ramón Abel
Small-area variation in health care affecting the choice of cesarean delivery: the case of a Colombian health insurer
description 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.
format Documento de trabajo (Working Paper)
author Vecino Ortiz, Andrés Ignacio
Bardey, David
Castaño Yepez, Ramón Abel
author_facet Vecino Ortiz, Andrés Ignacio
Bardey, David
Castaño Yepez, Ramón Abel
author_sort Vecino Ortiz, Andrés Ignacio
title Small-area variation in health care affecting the choice of cesarean delivery: the case of a Colombian health insurer
title_short Small-area variation in health care affecting the choice of cesarean delivery: the case of a Colombian health insurer
title_full Small-area variation in health care affecting the choice of cesarean delivery: the case of a Colombian health insurer
title_fullStr Small-area variation in health care affecting the choice of cesarean delivery: the case of a Colombian health insurer
title_full_unstemmed Small-area variation in health care affecting the choice of cesarean delivery: the case of a Colombian health insurer
title_sort small-area variation in health care affecting the choice of cesarean delivery: the case of a colombian health insurer
publisher Universidad del Rosario
publishDate 2009
url http://repository.urosario.edu.co/handle/10336/10850
_version_ 1645141742722220032
spelling ir-10336-108502019-09-19T12:37:01Z Small-area variation in health care affecting the choice of cesarean delivery: the case of a Colombian health insurer Vecino Ortiz, Andrés Ignacio Bardey, David Castaño Yepez, Ramón Abel Problemas & servicios de bienestar social Hospitales::Utilización Atención médica::Utilización Análisis multivariante Análisis de varianza Small-area variation Health care Procedure of delivery Multilevel analysis 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. 2009-10 2015-09-21T15:57:34Z info:eu-repo/semantics/workingPaper info:eu-repo/semantics/acceptedVersion Vecino 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. 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