Community health teams and health utilization in El Salvador.

The overutilization of costly hospital and emergency care and the underutilization of primary care is considered a key driver of wasteful health spending. We study how a shift toward community-based primary care reshapes care patterns across levels of the health system in El Salvador. Using data on outpatient consultations and hospitalizations across 254 municipalities, we exploit the staggered introduction of community health teams (CHTs) between 2010 and 2013 using an event-study design. We find that CHTs increased preventive care, reduced curative consultations for conditions amenable to effective primary care, and lowered preventable hospitalizations. We also document improved primary-care coverage for previously unattended chronic conditions. Together, these results suggest that strengthening primary care through CHTs can meaningfully improve the organization of care and bolster health system performance.