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An Ounce of Prevention for a Pound of Cure: Basic Health Care and Efficiency in Health Systems

Author

Listed:
  • Bancalari, Antonella
  • Bernal, Pedro
  • Celhay, Pablo
  • Martinez, Sebastian
  • Sánchez, María Deni
Abstract
We examine the efficiency gains in health systems generated after the national roll out of basic healthcare in El Salvador between 2010 and 2013. Using data from over 120 million consultations and five million hospitalizations, we demonstrate that the expansion of community health teams, comprising less-specialized health workers, increases preventive care and decreases curative care and preventable hospitalizations. We also estimate coverage improvements for previously unattended chronic conditions amenable to effective primary care. These results suggest that decentralization of tasks to less-specialized health workers improves efficiency, maintaining quality of care.

Suggested Citation

  • Bancalari, Antonella & Bernal, Pedro & Celhay, Pablo & Martinez, Sebastian & Sánchez, María Deni, 2024. "An Ounce of Prevention for a Pound of Cure: Basic Health Care and Efficiency in Health Systems," IDB Publications (Working Papers) 13433, Inter-American Development Bank.
    • Handle: RePEc:idb:brikps:13433
    DOI: http://dx.doi.org/10.18235/0005669
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    References listed on IDEAS

    as
    1. Mary Arends-Kuenning, 2001. "How do family planning workers’ visits affect women’s contraceptive behavior in bangladesh?," Demography, Springer;Population Association of America (PAA), vol. 38(4), pages 481-496, November.
    2. Bernal, Noelia & Carpio, Miguel A. & Klein, Tobias J., 2017. "The effects of access to health insurance: Evidence from a regression discontinuity design in Peru," Journal of Public Economics, Elsevier, vol. 154(C), pages 122-136.
    3. Clément de Chaisemartin & Xavier D'Haultfœuille, 2020. "Two-Way Fixed Effects Estimators with Heterogeneous Treatment Effects," American Economic Review, American Economic Association, vol. 110(9), pages 2964-2996, September.
    4. Pinchbeck, Edward W., 2019. "Convenient primary care and emergency hospital utilisation," Journal of Health Economics, Elsevier, vol. 68(C).
    5. David A. Hennessy, 2008. "Prevention and cure efforts both substitute and complement," Health Economics, John Wiley & Sons, Ltd., vol. 17(4), pages 503-511, April.
    6. Kolstad, Jonathan T. & Kowalski, Amanda E., 2012. "The impact of health care reform on hospital and preventive care: Evidence from Massachusetts," Journal of Public Economics, Elsevier, vol. 96(11), pages 909-929.
    7. Djavad Salehi‐Isfahani & M. Jalal Abbasi‐Shavazi & Meimanat Hosseini‐Chavoshi, 2010. "Family planning and fertility decline in rural Iran: the impact of rural health clinics," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 159-180, September.
    8. Dolton, Peter & Pathania, Vikram, 2016. "Can increased primary care access reduce demand for emergency care? Evidence from England's 7-day GP opening," Journal of Health Economics, Elsevier, vol. 49(C), pages 193-208.
    9. repec:idb:brikps:81118 is not listed on IDEAS
    10. Catalina Herrera-Almanza & Maria Rosales-Rueda, 2023. "Community-Based Health Programs and Child Vaccinations: Evidence from Madagascar," NBER Working Papers 31340, National Bureau of Economic Research, Inc.
    11. Richard Peter, 2021. "A fresh look at primary prevention for health risks," Health Economics, John Wiley & Sons, Ltd., vol. 30(5), pages 1247-1254, May.
    12. Robert E. Hall & Charles I. Jones, 2007. "The Value of Life and the Rise in Health Spending," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 122(1), pages 39-72.
    13. Gabriella Conti & Rita Ginja, 2023. "Who Benefits from Free Health Insurance?: Evidence from Mexico," Journal of Human Resources, University of Wisconsin Press, vol. 58(1), pages 146-182.
    14. Martha J. Bailey & Andrew Goodman-Bacon, 2015. "The War on Poverty's Experiment in Public Medicine: Community Health Centers and the Mortality of Older Americans," American Economic Review, American Economic Association, vol. 105(3), pages 1067-1104, March.
    15. Robert Nuscheler & Kerstin Roeder, 2016. "To Vaccinate or to Procrastinate? That is the Prevention Question," Health Economics, John Wiley & Sons, Ltd., vol. 25(12), pages 1560-1581, December.
    16. Alexander, Diane & Currie, Janet & Schnell, Molly, 2019. "Check up before you check out: Retail clinics and emergency room use," Journal of Public Economics, Elsevier, vol. 178(C).
    17. Herrera-Almanza, Catalina & Rosales-Rueda, Maria F., 2020. "Reducing the Cost of Remoteness: Community-Based Health Interventions and Fertility Choices," Journal of Health Economics, Elsevier, vol. 73(C).
    18. Dafny, Leemore & Gruber, Jonathan, 2005. "Public insurance and child hospitalizations: access and efficiency effects," Journal of Public Economics, Elsevier, vol. 89(1), pages 109-129, January.
    19. Miller, Sarah, 2012. "The effect of insurance on emergency room visits: An analysis of the 2006 Massachusetts health reform," Journal of Public Economics, Elsevier, vol. 96(11), pages 893-908.
    20. Bhalotra, Sonia R. & Nunes, Letícia & Rocha, Rudi, 2020. "Urgent Care Centers, Hospital Performance and Population Health," IZA Discussion Papers 13992, Institute of Labor Economics (IZA).
    21. Sun, Liyang & Abraham, Sarah, 2021. "Estimating dynamic treatment effects in event studies with heterogeneous treatment effects," Journal of Econometrics, Elsevier, vol. 225(2), pages 175-199.
    22. Christophe Courbage & Béatrice Rey, 2006. "Prudence and optimal prevention for health risks," Health Economics, John Wiley & Sons, Ltd., vol. 15(12), pages 1323-1327, December.
    23. Fuhmei Wang, 2018. "The roles of preventive and curative health care in economic development," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-12, November.
    24. Bhalotra, Sonia R. & Rocha, Rudi & Soares, Rodrigo R., 2019. "Does Universalization of Health Work? Evidence from Health Systems Restructuring and Expansion in Brazil," IZA Discussion Papers 12111, Institute of Labor Economics (IZA).
    25. Glazer, Jacob & McGuire, Thomas G., 2012. "A welfare measure of “offset effects” in health insurance," Journal of Public Economics, Elsevier, vol. 96(5), pages 520-523.
    26. Christopoulos, Konstantinos & Eleftheriou, Konstantinos, 2020. "The fiscal impact of health care expenditure: Evidence from the OECD countries," Economic Analysis and Policy, Elsevier, vol. 67(C), pages 195-202.
    27. William Whittaker & Laura Anselmi & Søren Rud Kristensen & Yiu-Shing Lau & Simon Bailey & Peter Bower & Katherine Checkland & Rebecca Elvey & Katy Rothwell & Jonathan Stokes & Damian Hodgson, 2016. "Associations between Extending Access to Primary Care and Emergency Department Visits: A Difference-In-Differences Analysis," PLOS Medicine, Public Library of Science, vol. 13(9), pages 1-19, September.
    28. Pascaline Dupas, 2011. "Health Behavior in Developing Countries," Annual Review of Economics, Annual Reviews, vol. 3(1), pages 425-449, September.
    29. Grant Miller & Diana Pinto & Marcos Vera-Hernández, 2013. "Risk Protection, Service Use, and Health Outcomes under Colombia's Health Insurance Program for the Poor," American Economic Journal: Applied Economics, American Economic Association, vol. 5(4), pages 61-91, October.
    30. Esra Kose & Siobhan M. O'Keefe & Maria Rosales-Rueda, 2022. "Does the Delivery of Primary Health Care Improve Birth Outcomes? Evidence from the Rollout of Community Health Centers," NBER Working Papers 30047, National Bureau of Economic Research, Inc.
    31. Mora-García, Claudio A. & Pesec, Madeline & Prado, Andrea M., 2024. "The effect of primary healthcare on mortality: Evidence from Costa Rica," Journal of Health Economics, Elsevier, vol. 93(C).
    32. Tania Barham, 2012. "Enhancing Cognitive Functioning: Medium-Term Effects of a Health and Family Planning Program in Matlab," American Economic Journal: Applied Economics, American Economic Association, vol. 4(1), pages 245-273, January.
    33. Fred Goldman & Michael Grossman, 1988. "The Impact of Public Health Policy: The Case of Community Health Centers," Eastern Economic Journal, Eastern Economic Association, vol. 14(1), pages 63-72, Jan-Mar.
    34. Achyuta Adhvaryu & Anant Nyshadham, 2015. "Return to Treatment in the Formal Health Care Sector: Evidence from Tanzania," American Economic Journal: Economic Policy, American Economic Association, vol. 7(3), pages 29-57, August.
    35. Herrera-Almanza, Catalina & Rosales-Rueda, Maria F., 2023. "Community-based health programs and child vaccinations: Evidence from Madagascar," World Development, Elsevier, vol. 170(C).
    36. Rebecca L. Thornton, 2008. "The Demand for, and Impact of, Learning HIV Status," American Economic Review, American Economic Association, vol. 98(5), pages 1829-1863, December.
    37. Hey, John D. & Patel, Mahesh S., 1983. "Prevention and cure? : Or: Is an ounce of prevention worth a pound of cure?," Journal of Health Economics, Elsevier, vol. 2(2), pages 119-138, August.
    38. Ding, Hui & Chen, Yiwei & Yu, Min & Zhong, Jieming & Hu, Ruying & Chen, Xiangyu & Wang, Chunmei & Xie, Kaixu & Eggleston, Karen, 2021. "The Effects of Chronic Disease Management in Primary Health Care: Evidence from Rural China," Journal of Health Economics, Elsevier, vol. 80(C).
    39. Aquino, R. & De Oliveira, N.F. & Barreto, M.L., 2009. "Impact of the Family Health Program on infant mortality in brazilian municipalities," American Journal of Public Health, American Public Health Association, vol. 99(1), pages 87-93.
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    More about this item

    Keywords

    community-based healthcare; efficiency; coverage;
    All these keywords.

    JEL classification:

    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • H21 - Public Economics - - Taxation, Subsidies, and Revenue - - - Efficiency; Optimal Taxation
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health

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