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The effect of primary healthcare on mortality: Evidence from Costa Rica

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  • Mora-García, Claudio A.
  • Pesec, Madeline
  • Prado, Andrea M.

Abstract

This paper uses the gradual implementation of a primary healthcare (PHC) intervention in Costa Rica to examine the long-term effect of PHC on mortality. Nine years after opening a primary care center, known as a Health Area, there was an associated 13% reduction in age-adjusted mortality rate in the assigned patient population. The effect was highest among adults over 65 years of age and for those with noncommunicable diseases, such as cardiovascular-related causes of death. We also show that as Health Areas opened, more individuals sought care at primary care clinics, while fewer sought care at emergency rooms; these changes may have partially mediated the effect of the intervention on mortality.

Suggested Citation

  • 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).
    • Handle: RePEc:eee:jhecon:v:93:y:2024:i:c:s0167629623001108
    DOI: 10.1016/j.jhealeco.2023.102833
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    1. Richard K. Crump & V. Joseph Hotz & Guido W. Imbens & Oscar A. Mitnik, 2009. "Dealing with limited overlap in estimation of average treatment effects," Biometrika, Biometrika Trust, vol. 96(1), pages 187-199.
    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. Fadlon, Itzik & Van Parys, Jessica, 2020. "Primary care physician practice styles and patient care: Evidence from physician exits in Medicare," Journal of Health Economics, Elsevier, vol. 71(C).
    4. Sarah Miller & Norman Johnson & Laura R Wherry, 2021. "Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(3), pages 1783-1829.
    5. Rodríguez Herrera, Adolfo, 2005. "La reforma de salud en Costa Rica," Documentos de Proyectos 3672, Naciones Unidas Comisión Económica para América Latina y el Caribe (CEPAL).
    6. 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.
    7. Adriana Lleras-Muney, 2005. "The Relationship Between Education and Adult Mortality in the United States," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 72(1), pages 189-221.
    8. 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.
    9. Sonia Bhalotra & Rudi Rocha & Rodrigo R. Soares, 2019. "Does Universalization of Health Work? Evidence from Health Systems Restructuring and Expansion in Brazil," Documentos de Trabajo 17122, The Latin American and Caribbean Economic Association (LACEA).
    10. 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.
    11. Romero Rocha & Rodrigo R. Soares, 2010. "Evaluating the impact of community‐based health interventions: evidence from Brazil's Family Health Program," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 126-158, September.
    12. Callaway, Brantly & Sant’Anna, Pedro H.C., 2021. "Difference-in-Differences with multiple time periods," Journal of Econometrics, Elsevier, vol. 225(2), pages 200-230.
    13. 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.
    14. Shi, Leiyu & Macinko, James & Starfield, Barbara & Politzer, Robert & Xu, Jiahong, 2005. "Primary care, race, and mortality in US states," Social Science & Medicine, Elsevier, vol. 61(1), pages 65-75, July.
    15. 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.
    16. Kruk, Margaret Elizabeth & Porignon, Denis & Rockers, Peter C. & Van Lerberghe, Wim, 2010. "The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives," Social Science & Medicine, Elsevier, vol. 70(6), pages 904-911, March.
    17. 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.
    18. Rosero-Bixby, Luis, 2004. "Spatial access to health care in Costa Rica and its equity: a GIS-based study," Social Science & Medicine, Elsevier, vol. 58(7), pages 1271-1284, April.
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