Borradores de Economía - Luck of the Draw: The Causal Effect of Physicians on Birth Outcomes
The series Working Papers on Economics is published by the Office for Economic Studies at the Banco de la República (Central Bank of Colombia). The works published are provisional, and their authors are fully responsible for the opinions expressed in them, as well as for possible mistakes. The opinions expressed herein are those of the authors and do not necessarily reflect the views of Banco de la República or its Board of Directors.
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.
