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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2018

Open Access 01-12-2018 | Research

The roll-out of a health insurance program and its impact on the supply of healthcare services: a new method to evaluate time-varying continuous interventions

Authors: Curtis Huffman, Edwin van Gameren

Published in: International Journal for Equity in Health | Issue 1/2018

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Abstract

Background

We analyze the effects of the Mexican universal health insurance program, Seguro Popular, on key variables associated with the provision of healthcare services. Given that the program was introduced gradually over a period that lasted more than a decade, the dynamics of the roll-out of the program and its reaction to the expansion of healthcare services it caused should be accounted for when evaluating the program.

Methods

We present a new semiparametric procedure to analyze time-varying continuous interventions. This is accomplished by bringing together the literatures on continuous and on dynamic treatments. Our approach allows the researcher to estimate mean and quantile dose-response functions by applying local regression methods to appropriately weighted samples that control for time-dependent confounding.

Results

Using administrative data, we show compelling evidence that Seguro Popular has incremented the human and physical resources available for healthcare services over the period 2001–2013. Moreover, we show that these effects have been heterogeneously distributed.

Conclusions

The program has proven most helpful in less vulnerable territories, leaving behind those in greater need.
Footnotes
1
Nearly all treatments of epidemiological interest present these characteristics –imagine a drug whose dose is readjusted according to the patient’s clinical response. Recently these tools, originally developed in biostatistics and epidemiology, have been applied in political science [8] to study the effectiveness of a candidate’s decision to “go negative” in political campaigns, an inherently dynamic process.
 
2
Our exposure variable is the (continuous) treatment intensity, that is, the number of SP affiliates relative to the number of eligible people, in each Sanitary Jurisdiction. The latter, therefore, are our program recipients.
 
3
FFGN proposed to estimate the mean DRF of a fixed continuous intervention using a kernel-weighted local linear regression of the outcome, Y, on the exposure, A, where each recipient’s kernel weight is divided by its exposure assignment model pdf properly evaluated.
 
4
The data is available at a yearly frequency disaggregated at the municipality level and can be retrieved from the SINAIS web site: http://​www.​dgis.​salud.​gob.​mx/​contenidos/​sinais/​estadisticas.​html.
 
6
It is important to note that it was not necessarily the case that every SJ got their corresponding share of financial resources, because the Regímenes Estatales para la Protección Social en Salud –State Regimes for Social Protection in Health– (REPSS) determined how and where to invest the program’s financial resources.
 
7
Since the SJs are comprised of several municipalities, we use the census data to approach the size of the target population.
 
8
Physicians and nurses without day-to-day contact with patients include those engaged in administrative tasks, educational activities, epidemiologists, and anatomic-pathologists.
 
9
The World Health Organization considers less than 2.3 health workers providing clinical care per 1000 people as a critical shortage.
 
10
A thorough investigation into the distributional effects would require the development of new procedures to estimate counterfactual distributions under different possible scenarios, a pending assignment for time-varying continuous interventions.
 
11
The absolute GINI inequality index, advocated by Kolm [34, 35], is unaffected by an equal addition to all incomes (translation invariant). while in the standard (relative) GINI index inequality is unchanged when all incomes are increased in the same proportion (scale invariant). Several other indices were also estimated showing the same tendency. Given that the absolute GINI index, that always considers improvement in terms of absolute difference, is not unit invariant we have normalized all indices so that 2002=100.
 
12
If, for example, we had ignored the dynamic nature of our empirical application, using only preprogram covariates in an attempt to control for confounders, evidence suggests that we would have overestimated the mean impact of the program [7], as we would have missed the fact that those SJs better off were the same making the most of the program at every point in time.
 
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Metadata
Title
The roll-out of a health insurance program and its impact on the supply of healthcare services: a new method to evaluate time-varying continuous interventions
Authors
Curtis Huffman
Edwin van Gameren
Publication date
01-12-2018
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2018
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-018-0874-1

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