Impact on prescription drug spending, health outcomes, and utilization of health services remains unclear
April 9, 2009–Mexico’s recent health reforms appear to have considerably reduced catastrophic and out-of-pocket health spending on both inpatient and outpatient medical procedures, especially among the poor, according to a new study published in The Lancet by a team of researchers—including two scientists from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. Known as Seguro Popular, the program reduced the proportion of poorer households that suffered from catastrophic health expenditures from 9.9 to 6.9 percent—a significant reduction that translates into major savings for thousands of Mexican families.
“These findings are really encouraging” says IHME researcher Dr. Emmanuela Gakidou. “Seguro Popular is a complex health reform and we’ve been able to show that the money being invested in the program is indeed reaching the poor households it was meant to target.”
In 2001, the Mexican government began rolling out Seguro Popular, a progressive new program to provide health insurance to 50 million uninsured Mexicans. One of the main goals of this multifaceted plan was to reduce the number of households forced to spend 30 percent or more of their disposable income on health care costs.
While other countries have implemented comprehensive health reforms, Mexico distinguished itself by prospectively building in a large-scale, randomized assessment of its reform. This allowed the study authors to undertake their unprecedented evaluation using innovative methods to overcome many of the political and ethical constraints which commonly plague public policy studies.
“We were pleased that our findings on catastrophic health spending were consistent with what previous, observational studies have found,” Dr. Gakidou says. “Our study also confirms that complex health system reform is feasible and can have a tangible positive impact, especially on those who need the most help.”
The study was unable to determine Seguro Popular’s impact on a number of other important outcomes beyond reductions in catastrophic spending on medical procedures, such as the impact on utilization of services or coverage of key interventions. The researchers note that additional analyses based on a longer assessment period are needed to determine other program effects.
“In light of impending health reform here in the United States, where the health care system is incredibly intricate, this is very exciting,” says Dr. Gakidou. “I’m hopeful that rigorous evaluation will be prioritized in the design and implementation of new US health policies so researchers can carefully measure the effects of American health reform and give feedback to policy makers and the public as the process evolves.”
Citation: King G, Gakidou E, Imai K, Lakin J, Moore RT, Nall C, Ravishankar N, Vargas M, Téllez-Rojo MM, Hernández Ávila JE, Hernández Ávila M, Hernández Llamas H. Public Policy for the poor? A randomised assessment of the Mexican universal health insurance programme. The Lancet. 2009 Apr 9; 373:1447–54.
