世界银行-抽签的运气_医生对出生结果的因果关系（英）-2025.6_70页_2mb

Luck of the Draw: The Causal Effect of Physicians on Birth Outcomes

Christian Posso, Jorge Tamayo, Arlen Guarin, Estefania Saravia

This study investigates the impact of physician skill levels on birth outcomes using experimental data from a Colombian government program that randomly assigns newly graduated physicians to local health centers (LHCs). The research finds that more-skilled physicians, identified through mandatory graduation exam scores, reduce the probability of unhealthy births (defined as low birth weight, prematurity, or low Apgar score) by approximately 9.14% compared to less-skilled physicians. This effect is consistent across individual health outcomes, with reductions ranging from 9.57% for low birth weight to 11.56% for low Apgar scores.

The methodology exploits random assignment to address selection bias and employs an instrumental variables approach, ensuring causal inference. Robustness checks, including placebo tests and alternative skill proxies, confirm the findings. The results highlight that more-skilled physicians improve birth outcomes primarily through better targeting of prenatal care to vulnerable mothers, without increasing the number of prenatal visits. This underscores the critical role of physician skill in maternal and child health, providing evidence for policies aimed at optimizing physician allocation in underserved areas.

Key findings:

• A one-standard-deviation increase in physician skill scores lowers unhealthy birth probability by 9.14%.
• Effects are robust across different birth outcome measures and skill proxies.
• No significant differences in effects across maternal subgroups or infant sexes.
• More-skilled physicians enhance care targeting but not overall volume of prenatal checkups.

This experimental design offers a unique opportunity to isolate the causal effect of physician quality, contributing to the broader literature on healthcare provider effectiveness and health outcomes.