Association for Public Policy Analysis & Management

To examine how preventive and primary care services affect elderly health this paper exploits a natural experiment that occurred in Costa Rica’s universal coverage single-payer healthcare system. It divides the country into health areas, that serve as a unit to administer health for the people who live in them. Each area has its own primary care network, and in 2004, a decision was made to increase the number of providers, but the selection of which Area got the new ones was not based on current demand. Thus, some people had increase access to healthcare while others didn’t.

I measure the effect of this treatment on healthcare utilization, nutritional outcomes, mental health, chronic diseases indicators and disability status using a difference-in-differences model. With the treatment, all the measures of healthcare utilization show a significant increase in consumption; and a significant increase in BMI (0.29) and drop in systolic blood pressure of (0.47 mmHg) and non-significant drop in glycated hemoglobin (0.08%). The findings are small and mixed, showing health possibly improving in some measurements and worsening in others.