The study details a two-year field experiment designed to evaluate Mexico's push to bring better healthcare to communities ranging from remote villages to urban areas. It turned dozens of Mexican communities into real-world laboratories where causal effects of the insurance programme could be empirically measured and evaluated at the household level as new services rolled out in phases across seven Mexican states.
The researchers developed the experimental design, wrote public-use software to implement and published a preliminary study detailing exactly how the experiment would be carried out. They then identified 74 matched pairs of communities that shared similar demographic and health conditions, and conducted household surveys capturing a baseline snapshot of each community's health status. The researchers randomly selected one from each matched pair of communities for early introduction of Seguro Popular, establishing a controlled framework in which individual changes in health experiences in one community could be empirically compared to control conditions in the matching community.
Residents in test areas were encouraged to enroll in Seguro Popular, and participating Mexican states received funds to upgrade medical facilities and improve access to health services, preventive care and medications. Follow-up surveys show the programme is making a difference on its primary objective, documenting a 23 percent reduction in families experiencing catastrophic health expenditures.
"This study shows: if money is put into a programme targeting the poor to receive health insurance, and if that programme is well structured, then the poor can actually see reductions in the amount they pay out of pocket for health care", Moore said. “That may seem obvious, but it is not. Designing a programme that is targeted in a certain way may not mean that resources actually reach the people it is intended to reach."
In fact, the study identified areas where Seguro Popular needs improvement, showing it is been slow in reaching some residents. The researchers found no measurable, first-year effect on medication spending, health outcomes or utilisation of health services.
MEDICA.de; Source: Washington University in St. Louis