Felipe Vásquez

Health equity in an unequal country: the use of medical services in Chile

IntroductionA recent health reform was implemented in Chile (the AUGE reform) with the objective of reducing the socioeconomic gaps to access healthcare. This reform did not seek to eliminate the private insurance system, which coexists with the public one, but to ensure minimum conditions of access to the entire population, at a reasonable cost and with a quality guarantee, to cover an important group of health conditions. This paper’s main objective is to enquire what has happened with the use of several healthcare services after the reform was fully implemented.MethodsConcentration and Horizontal Inequity indices were estimated for the use of general practitioners, specialists, emergency room visits, laboratory and x-ray exams and hospitalization days. The change in such indices (pre and post-reform) was decomposed, following Zhong (2010). A “mean effect” (how these indices would change if the differential use in healthcare services were evenly distributed) and a “distribution effect” (how these indices would change with no change in average use) were obtained.ResultsChanges in concentration indices were mainly due to mean effects for all cases, except for specialists (where “distribution effect” prevailed) and hospitalization days (where none of these effects prevailed over others). This implies that by providing more services across socioeconomic groups, less inequality in the use of services was achieved. On the other hand, changes in horizontal inequity indices were due to distribution effects in the case of GP, ER visits and hospitalization days; and due to mean effect in the case of x-rays. In the first three cases indices reduced their pro-poorness implying that after the reform relatively higher socioeconomic groups used these services more (in relation to their needs). In the case of x-rays, increased use was responsible for improving its horizontal inequity index.ConclusionsThe increase in the average use of healthcare services after the AUGE reform has not always led to improved equity in the use of such services in most services. This indicates that there are still barriers to the equitable use of healthcare services (e.g. insufficient medical human resources, financial barriers, capacity constraints, etc.) that have remained after the reform.

Assessing the Benefits and Costs of Dryland Forest Restoration in Central Chile

Investment in natural capital restoration is increasing as a response to the widespread ecological degradation of dryland forests. However, finding efficient mechanisms to promote restoration among private landowners is a significant challenge for policy makers with limited financial resources. Furthermore, few attempts have been made to evaluate the costs and benefits of restoration interventions even though this information is relevant to orient decision making. Hence, our goal was to estimate the benefits and costs of dryland forest restoration by means of reforestation with native trees in a study area in central Chile. To determine benefits we applied a Contingent Valuation questionnaire that allowed for the calculation of willingness to pay measures. Restoration costs were calculated based on market prices following existing technical recommendations developed for the study area. The results showed that the restoration project had a negative NPV irrespective of the discount rate applied in the analysis. Thus, the NPV varied between -US

Water Variability and the Economic Impacts on Small-Scale Farmers. A Farm Risk-Based Integrated Modelling Approach

71,000 and -US

Using stated preference methods to design cost-effective subsidy programs to induce technology adoption: An application to a stove program in southern Chile

258,000. The NPV attained positive results only for negative discount rates (US

Labor as a welfare measure in contingent valuation: the value of a forest restoration project

15,039 for -2%) and only when the national subsidy available for forest restoration was taken into account. This shows that landowners in Colliguay do not have incentives for carrying out restoration interventions due to a classic market failure: that in which ecosystems are mismanaged because many of their benefits are externalities from the perspective of landowners. Overall, these results stress the need for developing new compensation mechanisms and enhancing those in existence, with the aim of making restoration competitive with other land uses.

Income-related inequality in health and health care utilization in Chile, 2000 - 2009

Strengthening the planning of hydrological resources to optimize the use of water in agriculture is a key adaptation measure of the Chilean agricultural sector to cope with future climate change. To address this challenge, decision-makers call for tools capable of representing farmers’ behaviours under the likely stresses generated by future climate conditions. In this context, of special concern are the effects of water variability on small-scale farmers, who commonly operate with narrow profit margins and who lack access to financial resources and technological knowledge. This paper sheds light on the economic impacts of changes in water availability on small-scale agriculture. We provide a hydro-economic modelling framework that captures the socio-economic effects of water shocks on smallholders in the Vergara River Basin, Chile. This approach links a farm risk-based economic optimization model to a hydrologic simulation model adjusted for the basin. Our results indicate that at the aggregated level, there will be minor economic impacts of climate change on the basin’s small-scale agriculture, with small decreases in both expected utility and wealth. However, large differences in the economic impacts of wealthy and poor small-scale farmers are found. Changes in water availability, reduce the options of land reallocation to increase farmer’s expected utility, being the poor small-scale farmers the most negatively affected.

Estimating the Economic Value of Landscape Losses Due to Flooding by Hydropower Plants in the Chilean Patagonia

We study the design of an economic incentive based program - a subsidy - to induce adoption of more efficient technology in a pollution reduction program in southern Chile. Stated preferences methods, contingent valuation (CV), and choice experiment (CE) are used to estimate the probability of adoption and the willingness to share the cost of a new technology by a household. The cost-effectiveness property of different subsidy schemes is explored numerically for different regulatory objectives. Our results suggest that households are willing to participate in voluntary programs and to contribute by paying a share of the cost of adopting more efficient technologies. We find that attributes of the existing and the new technology, beyond the price, are relevant determinant factors of the participation decision and payment. Limited access to credit markets for low income families can be a major barrier for an effective implementation of these types of programs. Variations in the design of the subsidy and on the regulators objective and constraints can have significant impact on the level and the cost of reduction of aggregate emissions achieved.

The economic valuation of the recreational benefits of Dichato Beach (Tome-Chile)

AbstractI. Schiappacasse, F. Vasquez, L. Nahuelhual, and C. Echeverria. 2013. Labor as a welfare measure in contingent valuation: the value of a forest restoration project. Cien. Inv. Agr. 40(1):69-84. Monetary contributions might not be appropriate welfare measures in contingent valuation (CV) when household incomes are very low. In such cases, willingness to pay (WTP) is restricted by a household’s ability to reduce its consumption of other goods to pay for the environmental good under valuation. Beneficiaries, however, may be willing to contribute their time to work on a project instead of paying money. In this context, we assess the benefits of ecosystem services restoration in a rural area of high conservation value in central Chile, using a CV study that includes two WTP questions, one for cash and another for labor payments. The results indicate that labor payments in the form of a number of working hours per week were highly accepted among people. In fact, in our sample, more people were willing to pay with labor time than with traditional cash payments. When we analyze the economic efficiency of the restoration project considering only cash payments, the net present value (NPV) is negative (-US

Efecto de la variabilidad climática sobre la demanda de agua para uso residencial urbano: el caso de la ciudad de Manizales, Colombia

255,834), but when we consider the value of time payments, the NPV is US

Estimación de la demanda de agua para uso residencial urbano usando un modelo discreto-continuo y datos desagregados a nivel de hogar: el caso de la ciudad de Manizales, Colombia

629,980. The results indicate that this approach ought to be seriously considered in contingent valuation in similar social and economic contexts.