Welfare effects of health insurance in Mexico: The case of Seguro Popular de Salud.

Rocío García-Díaz,Edson Serván-Mori,Gustavo Nigenda,Sandra G Sosa-Rubí

doi:10.1371/journal.pone.0199876

Abstract

This study contributes with original empirical evidence on the distributional and welfare effects of one of the most important health policies implemented by the Mexican government in the last decade, the Seguro Popular de Salud (SPS). We analyze the effect of SPS on households’ welfare using a decomposable index that considers insured and uninsured households’ response to out-of-pocket (OOP) payments using both social welfare weights and inequality aversion. The disaggregation of the welfare index allows us to explore the heterogeneity of the SPS impact on households’ welfare. We applied propensity score matching to reduce the self-selection bias of being SPS insured. Overall results suggest non-conclusive results of the impact of SPS on households’ welfare. When we disaggregated the welfare index by different sub-population groups, our results suggest that households’ beneficiaries of SPS with older adults or living in larger cities are better protected against OOP health care payments than their uninsured counterparts. However, no effect was found among SPS-insured households living in rural and smaller cities, which is a result that could be attributed to limited access to health resources in these regions. Scaling up health insurance coverage is a necessary but not sufficient condition to ensure the protection of SPS coverage against financial risks among the poor.

Highlights

One of the most important concerns in developing countries is the increasing out-of-pocket (OOP) health care payment made by households and individuals
We use distributional welfare impact and the marginal welfare dominance approach to analyze the effect of Seguro Popular de Salud (SPS) on households’ welfare after OOP health payments, in different population groups in Mexico
The methodology shares some similarities with the concentration index, yet it allows us to decompose the welfare impacts in terms of OOP health care payments into its sources by analyzing its subgroup components

Summary

Introduction

One of the most important concerns in developing countries is the increasing out-of-pocket (OOP) health care payment made by households and individuals. Medical services to the beneficiaries are mainly offered through the public health network, which has increased access to outpatient, hospital and specialized care, in addition to medicines and laboratory services [12,13] This health insurance is focused on protecting uninsured households from excessive health expenditures that endanger their financial security. Given the widespread concern about how household welfare might be affected by OOP health payments, this paper focuses on analyzing the SPS welfare effect using an alternative methodology that measures the impact of OOP health payments on households’ income distribution. The OOP health payments dominance curves impose minimal ordinal structure on welfare indices in order to identify non-intersecting income distribution curves and to offer a robust ranking of alternatives Based on these elements, our study presents results of the distributional effect of the SPS in Mexico eight years after its initial implementation in 2003.

Materials and methods

Findings

Conclusions and discussion