Borradores de Economía - Luck of the Draw: The Causal Effect of Physicians on Birth Outcomes
La serie Borradores de Economía es una publicación de la Subgerencia de Estudios Económicos del Banco de la República. Los trabajos son de carácter provisional, las opiniones y posibles errores son responsabilidad exclusiva del autor y sus contenidos no comprometen al Banco de la República ni a su Junta Directiva.
The series Borradores de Economía (Working Papers on Economics) contributes to the dissemination and promotion of the work by researchers from the institution. On multiple occasions, these works have been the result of collaborative work with individuals from other national or international institutions. This series is indexed at Research Papers in Economics (RePEc). The opinions contained in this document are the sole responsibility of the author and do not commit Banco de la República or its Board of Directors.
Abstract
Identifying the impact of physicians on health outcomes is a challenging task due to the nonrandom sorting between physicians, hospitals, and patients. We overcome this challenge by exploiting a Colombian government program that randomly assigned 2,126 physicians to 618 small hospitals. We estimate the impact on the 256,806 children whose mothers received care in those hospitals during their pregnancy, using administrative data from the program, hospitals’ vital statistics records, and physicians’ records from mandatory health-specific graduation exams. We find that more-skilled physicians improve health at birth outcomes. That is, being assigned a physician with a one standard deviation higher performance in the health graduation exam scores decreases the probability of giving birth to an unhealthy baby by 6.31 percent. We present evidence that an underlying mechanism includes improving the targeting of care toward the more vulnerable mothers.
