Public policy for the poor? A randomised assessment of the Mexican universal health insurance programme.
BACKGROUND
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.


RESULTS
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.


CONCLUSIONS
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.
Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA.
Gary
G
King
Emmanuela
E
Gakidou
Kosuke
K
Imai
Jason
J
Lakin
Ryan T
RT
Moore
Clayton
C
Nall
Nirmala
N
Ravishankar
Manett
M
Vargas
Martha María
MM
Téllez-Rojo
Juan Eugenio Hernández
JE
Avila
Mauricio Hernández
MH
Avila
Héctor Hernández
HH
Llamas
D000328:Adult; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data; D006291:Health Policy; D006801:Humans; D007223:Infant; D007348:Insurance, Health; D008297:Male; D008800:Mexico; D009313:National Health Programs; D015397:Program Evaluation; D012959:Socioeconomic Factors; D019472:Universal Health Insurance