title: Heterogeneity in the effect of public health insurance on catastrophic out-of-pocket health expenditures: the case of Mexico.
abstract: Low- and middle-income countries increasingly provide broad-based public health coverage to their residents. One of the goals of such programmes is to reduce the extent to which beneficiaries incur catastrophic out-of-pocket expenditures on health care. A recent field experiment showed that on average Mexico's new public insurance programme reduced such expenditures in rural areas. Our reanalysis of that data, augmented with administrative data on health infrastructure, shows that this effect depends strongly on the type of health facility to which the beneficiary has access. A second analysis, based on data from Mexico's National Household Income and Expenditure Surveys (abbreviated ENIGH for its name in Spanish), substantiates those findings. It shows that catastrophic expenditures have fallen sharply for rural households with access to well-staffed facilities, but that they have fallen little if at all for rural households with access to poorly staffed facilities. Our analysis of the ENIGH also shows that Mexico's public health insurance programme has sharply reduced catastrophic spending among urban households. Considering that most Mexicans live either in urban areas or in rural areas with access to well-staffed facilities, our results show that the public health insurance programme has been largely successful in achieving one of its key goals. At the same time, our results show how difficult it can be to provide effective protection against catastrophic health expenditures for residents of remote rural areas.
authors.affiliation: Harris School of Public Policy Studies, University of Chicago, 1155 E. 60th St, Chicago, IL 60637, Chilean Ministry of Education, Evaluation Unit, 1371 Libertador Bernardo O'Higgins Ave, Santiago, Chile, Institute of Public Policy, Business and Economics Department, Universidad Diego Portales, 797 Santa Clara Ave, Huechuraba, Santiago, Chile and NORC at the University of Chicago, 55 East Monroe Street, Chicago, IL 60603. jgrogger@uchicago.edu.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Grogger
authors.affiliation: Harris School of Public Policy Studies, University of Chicago, 1155 E. 60th St, Chicago, IL 60637, Chilean Ministry of Education, Evaluation Unit, 1371 Libertador Bernardo O'Higgins Ave, Santiago, Chile, Institute of Public Policy, Business and Economics Department, Universidad Diego Portales, 797 Santa Clara Ave, Huechuraba, Santiago, Chile and NORC at the University of Chicago, 55 East Monroe Street, Chicago, IL 60603.
authors.forename: Tamara
authors.initials: T
authors.lastname: Arnold
authors.affiliation: Harris School of Public Policy Studies, University of Chicago, 1155 E. 60th St, Chicago, IL 60637, Chilean Ministry of Education, Evaluation Unit, 1371 Libertador Bernardo O'Higgins Ave, Santiago, Chile, Institute of Public Policy, Business and Economics Department, Universidad Diego Portales, 797 Santa Clara Ave, Huechuraba, Santiago, Chile and NORC at the University of Chicago, 55 East Monroe Street, Chicago, IL 60603.
authors.forename: Ana Sofía
authors.initials: AS
authors.lastname: León
authors.affiliation: Harris School of Public Policy Studies, University of Chicago, 1155 E. 60th St, Chicago, IL 60637, Chilean Ministry of Education, Evaluation Unit, 1371 Libertador Bernardo O'Higgins Ave, Santiago, Chile, Institute of Public Policy, Business and Economics Department, Universidad Diego Portales, 797 Santa Clara Ave, Huechuraba, Santiago, Chile and NORC at the University of Chicago, 55 East Monroe Street, Chicago, IL 60603.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Ome
mesh_terms: D002388:Catastrophic Illness / Q000191:economics*; D003695:Delivery of Health Care; D005382:Financing, Personal / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006268:Health Facilities / Q000592:standards; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008800:Mexico; D011634:Public Health; D019035:Rural Health Services
keywords: Health insurance; health facilities; health financing; policy evaluation; spatial analysis