Two Essays on the Economics of Health in Colombia

Abstract

This thesis studies two topics of the economics of health in a middle-income developing country: Colombia. In Chapter 2, I study the relationship between maternal exposure to terrorist violence during pregnancy and newborn birthweight. The identification strategy exploits the variation in the timing of exposure to the shock, which originates from the fluctuations of terrorist attacks over time and the stage of gestation when such an event occurs, and their geographic location across the municipalities of Colombia, a country with a lengthy internal armed conflict. Exposure to terrorist violence during early-pregnancy had a large negative impact on birthweight, but primarily for baby boys. Moreover, the effect of a violence shock was mitigated by the mothers' education. I also find that girls were affected, but mainly by shocks occurring at later stages of gestation, and that their mothers were more likely to drink and less likely to use prenatal care. This evidence exposes the importance of parental behavioural responses in shaping the effect of violence on newborn health. Chapter 3 is an evaluation of a reform to the insurance system for the poor in Colombia: the Subsidised Regime. It assesses the effectiveness of offering a deeper, more comprehensive package of health services, in protecting households from the financial burden of illness. Methodologically, the evaluation uses a difference-indifference with propensity score matching (DiD-PSM) methodology in a household panel dataset. The reform had little effect on healthcare use, and mixed outcomes for health expenditures. In urban areas of the country, there was a reduction in the likelihood of incurring in small and frequent out-of-pocket (OOP) expenditures, but not on the average amount spent. The main positive finding was a reduction in the dispersion of larger but less frequent expenditures, again in urban areas. The absence of an effect found in rural areas point to persistent gaps in healthcare access in these parts of the country.

Date of Award	1 Aug 2019
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Katsushi Imai (Supervisor) & Kunal Sen (Supervisor)