Fabián Duarte

Universal coverage systems remove monetary barriers to care, but they leave non-monetary barriers in place. This paper examines how much of the burden of such a barrier falls on those who live farthest from care, in a system where monetary barriers have been substantially removed by institutional design. I exploit staggered lockdowns in Chile, which raised the cost of reaching a healthcare facility without closing it, and find that distance, not price, determines who bears the loss. Copayment levels, which the system varies from zero to 20% across income tiers, show no detectable effect within any distance category, while the loss of guaranteed care deepens monotonically with distance to hospital, from 5.7% in the nearest quartile of municipalities to 13.3% in the farthest. Lockdowns raised the cost of leaving home for everyone, and utilization fell even where a hospital is within walking distance, but the loss more than doubles once patients have farther to travel. The disruption concentrates at the screening stage, where asymptomatic patients must initiate contact, while patients already in treatment show substantially smaller declines. Screening-dependent cancer mortality rises 8.8% at an eighteen-month lag in non-metropolitan regions, while mortality from non-screening cancers shows no effect at any lag, consistent with the causal chain from missed screening to excess deaths. These findings suggest that equalizing financial access, without addressing geographic access, leaves the binding constraint on equitable care unresolved.

This paper studies what happens to a private health insurance market when a regulatory crisis undermines institutional credibility. Using administrative data on 62 million individual-quarter observations from Chile's dual public-private system (2016 to 2025), I study how a 2022 Supreme Court ruling triggered market contraction through both exit and entry margins. Two sequential shocks, COVID-19 affecting access and the ruling affecting price, separately identify two channels of adverse selection. Sicker enrollees are less price-sensitive, and working-age sick enrollees value private coverage more when public-system access deteriorates. New entry into the private system collapsed by 75% peak-to-trough and adds roughly 30% to the net enrollment response to premium increases, a margin that exit-only models miss. Counterfactual decomposition attributes the vast majority of both excess exits and the entry collapse to the post-ruling regime shift rather than to price increases. The crisis created adverse selection where mild favorable selection had prevailed, while switching costs, a welfare-reducing friction in stable markets, acted as a stabilizing force by retaining sick enrollees.

We estimate the price elasticity of demand for private health insurance in Chile. Private health insurance plans in Chile adjust the base premium according to a policyholder's age and sex, in turn generating price discontinuities at certain ages. Using a multigroup multiperiod difference in difference method, we estimate the effect of these price increases on plan exit. We find an overall price elasticity of approximately −0.078. In addition, we find that high-income individuals are more price sensitive than low-income individuals and men less price sensitive than women. We also find evidence of nonlinearity with respect to the elasticity function.

This study investigates the relationship between nutritional status trajectories and academic performance among Chilean students from first to ninth grade between 2014 and 2022. Using a unique longitudinal panel dataset, we examine how becoming affected by overweight or obesity, as well as transitioning out of these states, influences academic outcomes such as percentile ranking and attendance. The findings demonstrate that becoming affected by overweight or obesity is associated with declines in academic performance, particularly for girls during adolescence. In contrast, exiting these states is linked to significant academic improvements for both boys and girls. By incorporating lagged dependent variables and school fixed effects, the analysis addresses potential biases, ensuring robust results. The results underscore the critical role of early interventions and sustained nutritional health management in enhancing educational outcomes, offering valuable insights for designing integrated health and education policies to tackle the global obesity epidemic.