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The European Journal of Health Economics
Published in: The European Journal of Health Economics 5/2010

Open Access 01-10-2010 | Original Paper

Health insurance for the poor: impact on catastrophic and out-of-pocket health expenditures in Mexico

Authors: Omar Galárraga, Sandra G. Sosa-Rubí, Aarón Salinas-Rodríguez, Sergio Sesma-Vázquez

Published in: The European Journal of Health Economics | Issue 5/2010

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Abstract

The goal of Seguro Popular (SP) in Mexico was to improve the financial protection of the uninsured population against excessive health expenditures. This paper estimates the impact of SP on catastrophic health expenditures (CHE), as well as out-of-pocket (OOP) health expenditures, from two different sources. First, we use the SP Impact Evaluation Survey (2005–2006), and compare the instrumental variables (IV) results with the experimental benchmark. Then, we use the same IV methods with the National Health and Nutrition Survey (ENSANUT 2006). We estimate naïve models, assuming exogeneity, and contrast them with IV models that take advantage of the specific SP implementation mechanisms for identification. The IV models estimated included two-stage least squares (2SLS), bivariate probit, and two-stage residual inclusion (2SRI) models. Instrumental variables estimates resulted in comparable estimates against the “gold standard.” Instrumental variables estimates indicate a reduction of 54% in catastrophic expenditures at the national level. SP beneficiaries also had lower expenditures on outpatient and medicine expenditures. The selection-corrected protective effect is found not only in the limited experimental dataset, but also at the national level.
Footnotes
1
The federal contribution per enrolled family consists of three components:(1) a quota per family provided by the federal government (the so called “social quota”) that represents 15% of one minimum salary; (2) an additional federal contribution (named “aportación solidaria federal”) that represents 1.5 times the quota per family; and (3) a state contribution that represents 0.5 times the quota per family [26].
 
2
By law, administrative costs cannot exceed 4% of the total federal budget transferred to the states for the SP program [28]. Analyzing the trends in operational costs of the National Commission for Social Protection in Health (or CNPSS for “Comisión Nacional de Protección Social en Salud”) in the period 2004-2007, those costs have not exceeded 4% of the total costs of the SP [26]. However, the administrative costs of managing the funds specifically designed for catastrophic health spending were not considered.
 
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Metadata
Title
Health insurance for the poor: impact on catastrophic and out-of-pocket health expenditures in Mexico
Authors
Omar Galárraga
Sandra G. Sosa-Rubí
Aarón Salinas-Rodríguez
Sergio Sesma-Vázquez
Publication date
01-10-2010
Publisher
Springer-Verlag
Published in
The European Journal of Health Economics / Issue 5/2010
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-009-0180-3

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