Subdermal contraceptive implants and repeat teenage motherhood: Evidence from a major maternity hospital-based program in Uruguay.

Teenage fertility is a social problem because of its private and public costs in countries of different development levels. Reductions in adolescent birth rates do not necessarily follow drops in overall fertility due to the demographic transition model. This paper analyses the impact of a subdermal contraceptive program on repeat teenage motherhood. Using a regression discontinuity design, we find that the intervention reduced mothers' likelihood of having another child in the next 48 months by 10 percentage points. This reduction is not random, and we also identify small positive selection in subsequent births.

Immigrant assimilation in health care utilisation in Spain.

Abundant evidence has tracked the labour market and health assimilation of immigrants, including static analyses of differences in how foreign-born and native-born residents consume health care services. However, we know much less about how migrants' patterns of healthcare usage evolve with time of residence, especially in countries providing universal or quasi-universal coverage. We investigate this process in Spain by combining all the available waves of the local health survey, which allows us to separately identify period, cohort, and assimilation effects. We find robust evidence of migrant assimilation in health care use, specifically in visits to general practitioners and emergency care and among foreign-born women. The differential effects of ageing on health care use between foreign-born and native-born populations contributes to the convergence of utilisation patterns in most health services after 15 years in Spain. Substantial heterogeneity by the time of arrival and by region of origin both suggest that studies modelling future welfare state finances would benefit from a more thorough assessment of migration.

Does robotization affect job quality? Evidence from European regional labor markets.

Whereas there are recent papers on the effect of robot adoption on employment and wages, there is no evidence on how robots affect non-monetary working conditions. We explore the impact of robot adoption on several domains of non-monetary working conditions in Europe over the period 1995-2005 combining information from the World Robotics Survey and the European Working Conditions Survey. In order to deal with the possible endogeneity of robot deployment, we employ an instrumental variables strategy, using the robot exposure by sector in other developed countries as an instrument. Our results indicate that robotization has a negative impact on the quality of work in the dimension of work intensity and no relevant impact on the domains of physical environment or skills and discretion.

Análisis de las cesáreas en Uruguay por tipo de centro hospitalario / An analysis of caesarean sections in Uruguay by type of hospital

Objetivo: Analizar comparativamente la incidencia de las cesáreas en los subsistemas de salud de Uruguay y en relación con los estándares de la Organización Mundial de la Salud (OMS) considerando las características médico-obstétricas de los partos, en especial la clasificación de Robson. Método: Se emplean 190.847 nacimientos registrados en el Sistema Informático Perinatal de Uruguay entre 2009 y 2014 por tipo de subsector sanitario. Mediante modelos logit se analiza la probabilidad de cesárea considerando la clasificación de Robson, otros factores de riesgo y las características de las madres. Se comparan las tasas de cesárea predichas por los distintos subsectores sanitarios para una población común. Asimismo, se contraponen las tasas de cesáreas observadas en cada subsistema con las que, hipotéticamente, se encontrarían si los hospitales siguiesen las pautas de la muestra de hospitales de referencia de la OMS. Resultados: El subsector privado, en términos generales, presenta una incidencia de cesáreas mucho más elevada que el público, incluso después de considerar las características médico-obstétricas de los nacimientos. Las tasas de cesáreas en Uruguay están más de un 75% por encima del valor que cabría esperar de acuerdo con el modelo de la OMS. Conclusiones: La incidencia de cesáreas en Uruguay es muy alta respecto a los estándares definidos por la OMS, en especial en el subsector privado. Este hecho no se explica por las características clínicas de los nacimientos.

Objective: To analyse on a comparative basis the incidence of caesarean sections among the different health care systems in Uruguay and with respect to the World Health Organization's (WHO) standards, taking into account the medical-obstetric characteristics of the births, particularly, the Robson classification. Methods: We examine 190,847 births registered by the Perinatal Information System in Uruguay between 2009 and 2014 by type of health care system. Using logit models, we analyse the probability of caesarean section taking into account the Robson classification, other risk factors and the mothers' characteristics. We compared the caesarean rates predicted by the different subsystems for a common population. Furthermore, we contrast the caesarean rates observed in each subsystem with the rates that resulted if the Uruguayan hospitals followed the guidelines of the sample of WHO reference hospitals. Results: Private health systems in Uruguay exhibit a much higher incidence of caesarean sections than public ones, even after considering the medical-obstetric characteristics of the births. Caesarean rates are more than 75% higher than those observed if the WHO standards are applied. Conclusions: Uruguay has a very high incidence of caesarean sections with respect to WHO standards, particularly, in the private sector. This fact is unrelated to the clinical characteristics of the births.

Análisis de las cesáreas en Uruguay por tipo de centro hospitalario / An analysis of caesarean sections in Uruguay by type of hospital

Objetivo: Analizar comparativamente la incidencia de las cesáreas en los subsistemas de salud de Uruguay y en relación con los estándares de la Organización Mundial de la Salud (OMS) considerando las características médico-obstétricas de los partos, en especial la clasificación de Robson. Método: Se emplean 190.847 nacimientos registrados en el Sistema Informático Perinatal de Uruguay entre 2009 y 2014 por tipo de subsector sanitario. Mediante modeloslogitse analiza la probabilidad de cesárea considerando la clasificación de Robson, otros factores de riesgo y las características de las madres. Se comparan las tasas de cesárea predichas por los distintos subsectores sanitarios para una población común. Asimismo, se contraponen las tasas de cesáreas observadas en cada subsistema con las que, hipotéticamente, se encontrarían si los hospitales siguiesen las pautas de la muestra de hospitales de referencia de la OMS. Resultados: El subsector privado, en términos generales, presenta una incidencia de cesáreas mucho más elevada que el público, incluso después de considerar las características médico-obstétricas de los nacimientos. Las tasas de cesáreas en Uruguay están más de un 75% por encima del valor que cabría esperar de acuerdo con el modelo de la OMS. Conclusiones: La incidencia de cesáreas en Uruguay es muy alta respecto a los estándares definidos por la OMS, en especial en el subsector privado. Este hecho no se explica por las características clínicas de los nacimientos

Objective: To analyse on a comparative basis the incidence of caesarean sections among the different health care systems in Uruguay and with respect to the World Health Organization's (WHO) standards, taking into account the medical-obstetric characteristics of the births, particularly, the Robson classification. Methods: We examine 190,847 births registered by the Perinatal Information System in Uruguay between 2009 and 2014 by type of health care system. Usinglogitmodels, we analyse the probability of caesarean section taking into account the Robson classification, other risk factors and the mothers’ characteristics. We compared the caesarean rates predicted by the different subsystems for a common population. Furthermore, we contrast the caesarean rates observed in each subsystem with the rates that resulted if the Uruguayan hospitals followed the guidelines of the sample of WHO reference hospitals. Results: Private health systems in Uruguay exhibit a much higher incidence of caesarean sections than public ones, even after considering the medical-obstetric characteristics of the births. Caesarean rates are more than 75% higher than those observed if the WHO standards are applied. Conclusions: Uruguay has a very high incidence of caesarean sections with respect to WHO standards, particularly, in the private sector. This fact is unrelated to the clinical characteristics of the births

[An analysis of caesarean sections in Uruguay by type of hospital]. / Análisis de las cesáreas en Uruguay por tipo de centro hospitalario.

OBJECTIVE: To analyse on a comparative basis the incidence of caesarean sections among the different health care systems in Uruguay and with respect to the World Health Organization's (WHO) standards, taking into account the medical-obstetric characteristics of the births, particularly, the Robson classification. METHODS: We examine 190,847 births registered by the Perinatal Information System in Uruguay between 2009 and 2014 by type of health care system. Using logit models, we analyse the probability of caesarean section taking into account the Robson classification, other risk factors and the mothers' characteristics. We compared the caesarean rates predicted by the different subsystems for a common population. Furthermore, we contrast the caesarean rates observed in each subsystem with the rates that resulted if the Uruguayan hospitals followed the guidelines of the sample of WHO reference hospitals. RESULTS: Private health systems in Uruguay exhibit a much higher incidence of caesarean sections than public ones, even after considering the medical-obstetric characteristics of the births. Caesarean rates are more than 75% higher than those observed if the WHO standards are applied. CONCLUSIONS: Uruguay has a very high incidence of caesarean sections with respect to WHO standards, particularly, in the private sector. This fact is unrelated to the clinical characteristics of the births.

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.

Evolution of adolescent fertility after decriminalization of abortion in Montevideo, Uruguay.

OBJECTIVE: To analyze the effect on adolescent fertility in Montevideo of the Uruguayan law on the voluntary termination of pregnancy that was passed in 2012. METHODS: The change in the number of births to teenage mothers between 2010 and 2014 was analyzed, along with their characteristics before and after decriminalization of abortion. RESULTS: Descriptive analysis of abortion before and after decriminalization showed that there was no reduction, during the period analyzed, in adolescent fertility, nor any changes in the distribution of births. CONCLUSION: The normative change brought about by the law on the voluntary termination of pregnancy was not associated with any substantial change in the reproductive behavior of adolescents in Montevideo. We recommend that this analysis is taken further with impact evaluation methodologies.

Evolution of adolescent fertility after decriminalization of abortion in Montevideo, Uruguay.

OBJECTIVE: To analyze the effect on adolescent fertility in Montevideo of the Uruguayan law on the voluntary termination of pregnancy that was passed in 2012. METHODS: The change in the number of births to teenage mothers between 2010 and 2014 was analyzed, along with their characteristics before and after decriminalization of abortion. RESULTS: Descriptive analysis of abortion before and after decriminalization showed that there was no reduction, during the period analyzed, in adolescent fertility, nor any changes in the distribution of births. CONCLUSION: The normative change brought about by the law on the voluntary termination of pregnancy was not associated with any substantial change in the reproductive behavior of adolescents in Montevideo. We recommend that this analysis is taken further with impact evaluation methodologies.

Effects of health care decentralization in Spain from a citizens' perspective.

The aim of this article is to analyze the impact of the decentralization of the public national health system in Spain on citizens' satisfaction with different dimensions of primary and hospital care. Using micro-data from the Health Barometer 1996-2009 and taking advantage of the exogeneity of the different pace of decentralization across Spain using a difference-in-differences strategy, we find that, in general, decentralization has not improved citizens' satisfaction with different features of the health services. In our base model, we find that there are even some small negative effects on a subset of variables. Sensitivity analysis confirms that there is no empirical evidence for supporting that decentralization has had a positive impact on citizens' satisfaction with health care. We outline several possible reasons for this.

Utilización de los servicios públicos de salud por parte de la población inmigrante latinoamericana en España

Objetivo. Identificar los patrones de utilización de los servicios públicos de salud en España por parte de la población inmigrante latinoamericana en comparación con la población local. Material y métodos. Se usó la información procedente de la Encuesta Nacional de Salud 2006 sobre la frecuencia de visitas a médicos de familia, médicos especialistas, servicios de urgencia y hospitalizaciones. La explotación se basa en el análisis descriptivo (contrastes de igualdad de medianas, proporciones y distribuciones) y el análisis multivariante (modelos binomiales negativos y probit). Resultados. El patrón de utilización de los servicios de salud por parte de los inmigrantes latinoamericanos resulta distinto del de la población local, salvo en el caso de las hospitalizaciones. Los resultados del análisis multivariante indican que sólo se aprecian diferencias estadísticamente significativas en el caso de hospitalizaciones (probabilidad de hospitalización 2.8 por ciento superior para latinoamericanos en último año) y de urgencias (0.205 visitas más que los españoles en el último año). Conclusiones. No se aprecian diferencias importantes entre el patrón de utilización de los servicios de salud de inmigrantes latinoamericanos y población nacional, con la excepción de una mayor utilización de los servicios de urgencias por los primeros.

Objective. To identify patterns of public health care utilization by Latin American immigrants in Spain as compared to the local population. Material and Methods. This analysis is based on information provided by the 2006 National Health Survey on the frequency of visits to general practitioners, specialists and emergency rooms, as well as hospital stays. The study uses a descriptive analysis involving tests of equality of distributions, medians and proportions, and a multivariate analysis with binomial negative and probit models. Results. The distribution of Latin American immigrants show lower utilization rates of public health care services than the native-born population, with the exception of hospital stays. The pattern of health care use by Latin Americans and Spaniards is different, with the exception of hospital stays. The results of the multivariate analysis indicate statistically significant differences only in the case of hospital stays (the probability of staying in a hospital in the last year is 2.8 percent higher for Latin American immigrants than among locals) and utilization of emergency rooms (0.205 more visits than the Spanish-born population). Conclusions. There is no significant difference in utilization of public health care between Latin American immigrants and native-born populations in Spain, with the exception of a higher frequency of use of emergency rooms by the former.

Health care utilisation and immigration in Spain.

The aim of this work was to analyse the use of health care services by immigrants in Spain. Using a nationally representative health survey from 2006-2007 and negative binomial and hurdle models, it was found that there is no statistically significant difference in the patterns of visits to general practitioners and hospital stays between migrants and natives in Spain. However, immigrants have a lower access to specialists and visit emergency rooms with a higher frequency than nationals.