Ex-post evaluation of environmental decontamination plans on air quality in Chilean cities.

This paper evaluates the impact of the Environmental Decontamination Plans (known as PDAs) on air quality in Chilean cities, for which the differences in differences method was used during the period between 2010 and 2017. The ex-post evaluation shows that the implementation of a PDA for PM10 has no impact on the monthly concentrations of PM10. However, the new PDAs for PM2.5 (that were implemented starting in 2015) reduce the monthly concentrations of PM10 by approximately 8 µg/m3, although they have not reduced the monthly concentrations of PM2.5. Thus, it is concluded that the assumptions and scenarios used in the ex-ante evaluations to project the reduction of PM2.5 concentrations in the PDAs are extremely optimistic in relation to their current contribution to improving air quality in Chile.

Assessing the impact of More Doctors Program on health care indicators

This paper aims to assess the short run effects of the More Doctors Program, launched by the Brazilian federal government in 2013. Using differences-in-differences approach with municipal data collected between 2010 and 2015, we confirm that MDP has two correlated impacts. First, it has increased health service attendance on treated municipalities. We document that appointments, consults, referrals, and home visits have increased by 5.9%, 9.4%, 12.3%, and 29.7%. Second, we find a negative impact on hospitalization. We argue that intensification on health service access have reduced general hospitalization (4.6%). However, it does not seem to have been able to reduce mortality in the municipalities, in line with Carrilo and Feres (2018) and Fontes et al. (2017). We argue that increase in referrals and appointment with specialists can be interpreted as quality improvement, since a more precise diagnostic, can reduce hospitalization due to faster health recovery without an impact on mortality.

Evaluating the impact of physicians' provision on primary healthcare: Evidence from Brazil's More Doctors Program.

This study aims to evaluate the More Doctors Program (Programa Mais Médicos) in terms of the provision of physicians, presenting estimates of its impact on hospitalization for ambulatory care sensitive conditions. The differences-in-differences method was used with propensity score matching (double difference matching), using 3 specifications, a falsification test, and also a dynamic endogeneity test to confirm the robustness of the results. For the application of this methodology, a panel of municipal data was constructed covering several variables related to socioeconomic, demographic, and public health infrastructure characteristics in the cities for the period from 2010 to 2016. The results show a significant reduction in hospital admissions in treated municipalities with an increasing and perceptible effect in the second year of the program.

The impact of the legalisation of abortion on birth outcomes in Uruguay.

This study investigates the short-term impact on the quantity and quality of births of an abortion reform in Uruguay that legalised termination of pregnancy until the 12th week of pregnancy in the short run. We employ a differences-in-differences approach, comprehensive administrative records of births, and a novel identification strategy based on the planned or unplanned nature of pregnancies that came to term. Our results suggest that this policy change has led to an 8% decline in the number of births from unplanned pregnancies, driven by the group of mothers aged between 20 and 34 years old who have secondary education. This decline has triggered an increase in the average quality of births in terms of more intensive prenatal control care and a lower probability of births among single mothers. Furthermore, we document a positive selection process of births because of the reform, as adequate prenatal control care and Apgar scores rose among the affected demographic group.

Impacto de una política de equivalencia terapéutica en el precio de medicamentos en Chile / Impact of a therapeutic equivalence policy on the price of drugs in Chile

Bioequivalence has become a standard request for drug commercialization in most high income countries, and significant efforts have been made to implement it in many low and middle income countries. In Chile, the requirement of bioequivalency has been gradually implemented since 2008, associated to a communicational campaign to inform the general population about its scope and importance. The objective of this study is to estimate the effect of the implementation of bioequivalence on the prices of products that have been affected by this policy. We conducted a difference in difference study in a set of 30 chronic use drugs, selected from the eighty clinical guidelines published by the Chilean Ministry of Health. The effect was assessed according to the date when the corresponding ministerial decree was published. A control drugs was selected for each analyzed medication in order to estimate the effect of implementation independently of other factors of the market. We identified three groups of drugs: (i) those which experimented a significant increment of price due to bioequivalence; (ii) those where prices decreased; and (iii) those where prices did not (significantly changed) decrease. A sensitivity analysis complemented the study results and identified the significant effect of the date when the bioequivalence was implemented. It is concluded that the implementation of bioequivalence in Chile had a significant effect on prices of some medications. However, the magnitude and direction of such effect depends on the characteristics of the particular market defined by each drug.(AU)

Impacto de una Política de Equivalencia Terapéutica en el Precio de Medicamentos en Chile.

Bioequivalence has become a standard request for drug commercialization in most high income countries, and significant efforts have been made to implement it in many low and middle income countries. In Chile, the requirement of bioequivalency has been gradually implemented since 2008, associated to a communicational campaign to inform the general population about its scope and importance. The objective of this study is to estimate the effect of the implementation of bioequivalence on the prices of products that have been affected by this policy. We conducted a difference in difference study in a set of 30 chronic use drugs, selected from the eighty clinical guidelines published by the Chilean Ministry of Health. The effect was assessed according to the date when the corresponding ministerial decree was published. A control drugs was selected for each analyzed medication in order to estimate the effect of implementation independently of other factors of the market. We identified three groups of drugs: (i) those which experimented a significant increment of price due to bioequivalence; (ii) those where prices decreased; and (iii) those where prices did not (significantly changed) decrease. A sensitivity analysis complemented the study results and identified the significant effect of the date when the bioequivalence was implemented. It is concluded that the implementation of bioequivalence in Chile had a significant effect on prices of some medications. However, the magnitude and direction of such effect depends on the characteristics of the particular market defined by each drug.

Spillovers of health education at school on parents' physical activity.

This paper exploits state health education (HED) reforms as quasi-natural experiments to estimate the causal impact of HED received by children on their parents' physical activity. We use data from the Panel Study of Income Dynamics for the period 1999-2005 merged with data on state HED reforms from the National Association of State Boards of Education Health Policy Database and the 2000 and 2006 School Health Policies and Programs Study. To identify the spillover effects of HED requirements on parents' behavior, we use several methodologies (triple differences, changes in changes, and difference in differences) in which we allow for different types of treatments. We find a positive effect of HED reforms at the elementary school on the probability of parents doing light physical activity. Introducing major changes in HED increases the probability of fathers engaging in physical activity by between 6.3 and 13.7 percentage points, whereas on average, this probability for mothers does not seem to be affected. We analyze several heterogeneous impacts of the HED reforms to unveil the mechanisms behind these spillovers. We find evidence consistent with hypotheses such as gender specialization of parents in childcare activities or information sharing between children and parents.