Publicity and Compliance in the Colombia Tutela
Last registered on January 07, 2015

Pre-Trial

Trial Information
General Information
Title
Publicity and Compliance in the Colombia Tutela
RCT ID
AEARCTR-0000571
Initial registration date
January 07, 2015
Last updated
January 07, 2015 4:14 PM EST
Location(s)
Region
Primary Investigator
Affiliation
Emory University
Other Primary Investigator(s)
PI Affiliation
World Bank
Additional Trial Information
Status
Completed
Start date
2013-10-01
End date
2014-07-31
Secondary IDs
Abstract
The Colombian tutela provides a swift mechanism for resolving state violations of individual rights. The Colombian Constitutional Court has provided innovative solutions through tutela to a variety of systemic bureaucratic failures, yet, the practical impact of these innovations depends on the ability of claimants to obtain through a court order what they could not get on their own, and that depends on compliance. Compliance is commonly monitored in legal systems via indirect monitoring, where litigants are themselves responsible for alerting judges to problems. Recently courts have begun directly monitoring compliance by tracking their own orders. We conduct a cluster randomized trial designed to evaluate the effect of direct compliance monitoring. Specifically, we consider the effect of increasing health provider expectations that the Colombian public will become aware of their activities on compliance with tutela orders governing health rights. Our hypothesis is that providers that expect public scrutiny of their behavior will experience better compliance outcomes than providers who do not.
External Link(s)
Registration Citation
Citation
Gauri, Varun and Jeffrey Staton. 2015. "Publicity and Compliance in the Colombia Tutela." AEA RCT Registry. January 07. https://www.socialscienceregistry.org/trials/571/history/3370
Sponsors & Partners

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Experimental Details
Interventions
Intervention(s)
The aim of the treatment was to inform Empresas Promotoras de Salud (EPS), health maintenance organizations responsible for the delivery of health services in Colombia, that their compliance record with respect to orders in tutela cases was being tracked and that it would be publicized upon review. We informed treated EPS's that we were working in partnership with the Constitutional Court. Treatment involved a letter addressed to the President and Managing Directors of a selected EPS's, as well as follow up discussions with any EPS that reached out to our research team. The letter explained the purpose of the study, reviewed the results of our pilot study reporting the overall average compliance rates in the health sector, and a promise to publish the results of the study in July of 2014.
Intervention Start Date
2014-02-25
Intervention End Date
2014-03-03
Primary Outcomes
Primary Outcomes (end points)
The key outcome is a binary indicator of compliance problems, measured at the level or each tutela order. It takes on the value of 1 in the event that our research team determined (via a careful reading of each tutela case and an interview with the beneficiary of relief) that there was an instance of non-compliance, either partial or complete. The indicator also takes on the value of 1 in the event that there had been compliance but there was a delay that violated the terms of the order. Otherwise, the indicator is coded 0.

We also have categorical measures of compliance and of timing, both judged subjectively by the interviewed litigant and by our team. In addition, we conduct semi-interviews with EPS's in the study and have qualitative measures of each EPS's protocol for dealing with tutela orders.
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
We conduct a cluster-randomized field experiment. There are 32 clusters, each cluster reflecting a single EPS. EPS's are blocked by the health care regime that they manage. EPS's that manage insured in the contributing regime (where individuals contribute to their premiums) constitute one block. The other block includes EPS's that manage insured in the subsidized regime (where premiums are paid for by the state). Fifteen EPS's managed insured exclusively in the subsidized regime. Eleven managed insured exclusively in the contributing regime. Five EPS's managed the care of individuals in both regimes and the regime for a single EPS was unclear. We randomly assign these six EPS's to the subsidized or contributing regime blocks. We then randomize treatment within each block.
Experimental Design Details
Randomization Method
Randomization done in office by a computer.
Randomization Unit
The randomization unit is an EPS.
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
32
Sample size: planned number of observations
288
Sample size (or number of clusters) by treatment arms
The sample size for each arm was 144.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
We assumed that we would seek to detect a change in probability of compliance from 0.5 to 0.7. For an alpha level of 0.05, power of 0.8, an intracluster correlation of 0.05, we required 144 cases per arm and an average cluster size of 9.
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
Emory Institutional Review Board
IRB Approval Date
2013-03-04
IRB Approval Number
IRB00057134
Analysis Plan

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Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
No
Is data collection complete?
Data Publication
Data Publication
Is public data available?
No
Program Files
Program Files
Reports and Papers
Preliminary Reports
Relevant Papers