Public Policy for the Poor? A Randomised Assessment of the Mexican Universal Health Insurance Programme
Moore, Ryan T.
Téllez-Rojo, Martha Maria
Ávila, Juan Eugenio Hernández
Ávila, Mauricio Hernández
Llamas, Héctor HernándezNote: Order does not necessarily reflect citation order of authors.
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CitationKing, Gary, Emmanuela Gakidou, Kosuke Immai, Jason Lakin, Ryan T. Moore, Clayton Nail, Nirmala Ravishankar, et al. 2009. Public policy for the poor? A randomised assessment of the Mexican universal health insurance programme. Lancet 373(9673): 1447-54.
AbstractBackground: We assessed aspects of Seguro Popular, a programme aimed to deliver health insurance, regular and preventive medical care, medicines, and health facilities to 50 million uninsured Mexicans. Methods: We randomly assigned treatment within 74 matched pairs of health clusters—ie, health facility catchment areas—representing 118 569 households in seven Mexican states, and measured outcomes in a 2005 baseline survey (August, 2005, to September, 2005) and follow-up survey 10 months later (July, 2006, to August, 2006) in 50 pairs (n=32 515). The treatment consisted of encouragement to enrol in a health-insurance programme and upgraded medical facilities. Participant states also received funds to improve health facilities and to provide medications for services in treated clusters. We estimated intention to treat and complier average causal eﬀects non-parametrically. Findings: Intention-to-treat estimates indicated a 23% reduction from baseline in catastrophic expenditures (1·9% points; 95% CI 0·14–3·66). The eﬀect in poor households was 3·0% points (0·46–5·54) and in experimental compliers was 6·5% points (1·65–11·28), 30% and 59% reductions, respectively. The intention-to-treat eﬀect on health spending in poor households was 426 pesos (39–812), and the complier average causal eﬀect was 915 pesos (147–1684). Contrary to expectations and previous observational research, we found no eﬀects on medication spending, health outcomes, or utilisation. Interpretation: Programme resources reached the poor. However, the programme did not show some other eﬀects, possibly due to the short duration of treatment (10 months). Although Seguro Popular seems to be successful at this early stage, further experiments and follow-up studies, with longer assessment periods, are needed to ascertain the long-term eﬀects of the programme. Funding: Mexican Ministry of Health, the National Institute of Public Health of Mexico, and Harvard University Institute for Quantitative Social Science
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:5130448
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