Like most of the world, low- and middle-income countries have faced a growing demand for new health technologies and higher budget constraints. It is necessary to have technical instruments to make decisions based on real-world evidence that allows maximization of the population’s health with a limited budget. We estimated the supply-based cost-effectiveness elasticity, which was then used to determine the cost-effectiveness threshold for the healthcare system of Colombia, a middle-income country where multiple insurers, paid under capitation rules, manage the compulsory contributions of the citizens and government subsidies. Using administrative data, we explored the variation of health expenditures and outcomes at the insurer, geographical region, diagnosis group, and year levels. To deal with endogeneity in a two-way fixed-effects model, we instrumented health expenditures using characteristics of the health system such as drug-price regulation. We estimated the threshold to be US$ 4487.5 per YLL avoided (14.7 million COP at 2019 prices) and US$ 5180.8 per QALY gained (17 million COP at 2019 prices), around one times the GDP per capita. To our knowledge, this is the first estimation of the cost-effectiveness threshold elasticity supply-based in a middle-income country with a managed care health system.
This paper uses primary micro-data from Indian households residing in rural villages and poor urban neighbourhoods to shed light on household sanitation decision-making. We use a theoretical economic model to reduce the dimensionality and complexity of this process. Beyond the most commonly analysed motivator, health, we consider economic and non-pecuniary benefits. We provide empirical evidence that each of these margins matter, and do so in both rural and urban contexts, and discuss how our findings can be explored in sanitation policy and programme design.
BackgroundTobacco prevalence in Colombia is small compared with other Latin America despite the nation’s tobacco taxes being among the lowest in the region. However, tobacco taxes have increased several times during the last decade, and large increases in 2010 and 2016 impacted consumer prices.ObjectiveThis paper aims to estimate the price smoking participation elasticity (PPE) in Colombia, with specific reference to regional increases in consumer prices after 2010 tax policy changes.MethodsThe PPE is computed using logistic regression based on individual-level data from the National Psychoactive Substances Consumption Survey for 2008 and 2013. Our specific focus is state-level variation in Colombian cigarette prices between 2008 and 2013 induced by the tax hike in 2010.ResultsThe estimated PPE in Colombia is around −0.66 (p value=0.046). We find almost no differences across socioeconomic level, but price sensitivity was greater for women than men, and for relatively older individuals (ages 51–64).ConclusionsPPE for Colombia is above estimates for comparable middle-income countries such as Mexico. As a result, current estimates for health gains of tax policies are likely to be underestimated. Moreover, in contrast with the literature, we find that the PPE for the youth (≤25 years) is lower than older age groups, and there is no evidence of a prominent socio-economic status (SES) gradient.
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