Resumen en inglés

This thesis examines challenges in accessing healthcare services, focusing on the relationship between coverage and access. By leveraging unique healthcare interventions, this research explores the effects of expanding coverage on service utilization and examines the impact of insurance company closures on access to care. Additionally, the thesis provides an analysis of the diverse barriers that hinder individuals from accessing healthcare services. Chapter 1 leverages a reform that increased the range of available health services for approximately fifty percent of the population. Using a difference-in-differences approach, this chapter analyzes the effects of offering a more comprehensive range of health services on insured individuals’ utilization of health services and public expenditure per patient. The findings indicate that expanding the health plan to include more services increased health service utilization among eligible individuals compared to non-eligible individuals. However, there were no significant differences in public expenditure per patient between the two groups, likely due to the fee negotiation process. Chapter 2 examines the closure of one of Colombia’s largest insurers in 2015, which resulted in the random reassignment of policyholders to other insurers. Consequently, the receiving insurers experienced a sudden and unexpected influx of new affiliates, leading to varying levels of congestion. Using a difference-in-differences empirical strategy, this chapter investigates the impact of insurers’ congestion and quality on healthcare service utilization. The findings suggest that individuals transferred to more congested insurers experienced decreased healthcare utilization compared to those transferred to less congested insurers. Conversely, individuals transferred to higher-quality insurers exhibited increased healthcare utilization relative to those transferred to lower-quality insurers. Moreover, high-quality insurers were able to mitigate the adverse effects of congestion. Chapter 3 provides a comparative analysis of access barriers to health services in Colombia and the Dominican Republic. Using a mixed-methods methodology, the study reveals that in Colombia, the most frequently cited barriers relate to organizational accessibility and difficulties in contacting health services. In contrast, barriers in the Dominican Republic primarily center on availability and financial affordability.