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The effects of mobile primary health teams: Evidence from the Médico del Barrio strategy in Ecuador

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  • Galárraga, Omar
  • Quijano-Ruiz, Alonso
  • Faytong-Haro, Marco

Abstract

Starting in 2017, Ecuador gradually expanded its primary healthcare access program nationwide using mobile traveling healthcare teams through the Estrategia Médico del Barrio (EMB) [or Neighborhood Doctor Strategy]. EMB teams, composed of a primary care physician, a nurse, and a community health worker, made home visits in marginalized areas. We estimate the impact of the EMB on health and utilization outcomes using nationally representative household surveys for 2006 (N = 55,666), 2012–13 (N = 92,500) and 2018–19 (N = 168,747). The treatment variable at the extensive margin is any exposure to EMB at the canton level. At the intensive margin, we use exposure in terms of weeks covered by EMB and the number and composition of EMB personnel per 1000 population. We identify outcomes of treated vs. non- or partially-treated cantons based on the random combination of the timing of the start of the program’s implementation and the timing of the survey interview, which varied across cantons. We use difference-in-difference (DD) and difference-in-difference-in-difference (DDD) frameworks, the latter for cantons with high indigenous concentration. We find significant effects on the reported health problem and preventive care, but mixed results in terms of curative healthcare. The DDD specification shows that EMB improved health problem diagnoses and preventive healthcare utilization, including in highly indigenous cantons, yet it seemed to have mixed results in terms of curative care use in Ecuador. Various alternative specifications and robustness tests do not qualitatively alter the main findings.

Suggested Citation

  • Galárraga, Omar & Quijano-Ruiz, Alonso & Faytong-Haro, Marco, 2024. "The effects of mobile primary health teams: Evidence from the Médico del Barrio strategy in Ecuador," World Development, Elsevier, vol. 181(C).
  • Handle: RePEc:eee:wdevel:v:181:y:2024:i:c:s0305750x24001293
    DOI: 10.1016/j.worlddev.2024.106659
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    References listed on IDEAS

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    1. Augustine Asante & Jennifer Price & Andrew Hayen & Stephen Jan & Virginia Wiseman, 2016. "Equity in Health Care Financing in Low- and Middle-Income Countries: A Systematic Review of Evidence from Studies Using Benefit and Financing Incidence Analyses," PLOS ONE, Public Library of Science, vol. 11(4), pages 1-20, April.
    2. Julian Cristia & William N. Evans & Beomsoo Kim, 2015. "Improving the Health Coverage of the Rural Poor: Does Contracting-Out Mobile Medical Teams Work?," Journal of Development Studies, Taylor & Francis Journals, vol. 51(3), pages 247-261, March.
    3. Papanicolas, Irene & Woskie, Liana R. & Jha, Ashish K., 2018. "Health care spending in the United States and other high-income countries," LSE Research Online Documents on Economics 87362, London School of Economics and Political Science, LSE Library.
    4. Luiz Felipe Campos Fontes & Otavio Canozzi Conceição & Paulo de Andrade Jacinto, 2018. "Evaluating the impact of physicians' provision on primary healthcare: Evidence from Brazil's More Doctors Program," Health Economics, John Wiley & Sons, Ltd., vol. 27(8), pages 1284-1299, August.
    5. Witmer, A. & Seifer, S.D. & Finocchio, L. & Leslie, J. & O'Neil, E.H., 1995. "Community health workers: integral members of the health care work force," American Journal of Public Health, American Public Health Association, vol. 85(8), pages 1055-1058.
    6. Ralph Chapman & Michael Keall & Philippa Howden-Chapman & Mark Grams & Karen Witten & Edward Randal & Alistair Woodward, 2018. "A Cost Benefit Analysis of an Active Travel Intervention with Health and Carbon Emission Reduction Benefits," IJERPH, MDPI, vol. 15(5), pages 1-10, May.
    7. Frijters, Paul & Lalji, Chitwan & Pakrashi, Debayan, 2020. "Daily weather only has small effects on wellbeing in the US," Journal of Economic Behavior & Organization, Elsevier, vol. 176(C), pages 747-762.
    8. Mengyao Li & Susana Ferreira & Travis A Smith, 2020. "Temperature and self-reported mental health in the United States," PLOS ONE, Public Library of Science, vol. 15(3), pages 1-20, March.
    9. Sinem Kınay Savaşer & Bahar Yetis Kara, 2022. "Mobile healthcare services in rural areas: an application with periodic location routing problem," OR Spectrum: Quantitative Approaches in Management, Springer;Gesellschaft für Operations Research e.V., vol. 44(3), pages 875-910, September.
    10. Christopher Carpenter & Carlos Dobkin, 2011. "The Minimum Legal Drinking Age and Public Health," Journal of Economic Perspectives, American Economic Association, vol. 25(2), pages 133-156, Spring.
    11. Galárraga, Omar & Harris, Jeffrey E., 2021. "Effect of an abrupt change in sexual and reproductive health policy on teen birth rates in Ecuador, 2008–2017," Economics & Human Biology, Elsevier, vol. 41(C).
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