One of the best courses I ever took, was a course on empirical methods taught by Gary King in the Government Department at Harvard. That is why I think it is so great that he now does Global Health research.
Mexico has been credited as one of the countries that has done the most to expand access to health services in a “developing” country context. Starting in 2003, the government launched a series of reforms to introduce universal health insurance, which is subsidized for the poor. The program, known as Seguro Popular, aimed to provide coverage to 50 million uninsured Mexican.
Gary King and co-authors launched a randomized clustered evaluation of the program on a large sample of households. The treatment was encouragement to join insurance as well as additional funds to upgrade the facilities in the areas. They used a random phase-in of the program, which is pretty cool and something I wish more countries used, to study the program effects.
After 10 months, the authors did find evidence that the program had been successful in reducing overall catastrophic and out-of-pocket expenditures for inpatient and outpatient medical procedures, and that the findings were strongest for the poorest individuals. However, the program had no effect on medication spending, health outcomes, or utilization. This finding was not consistent with previous observational studies.
There are a lot of potential reasons for these results, which the authors discuss in depth in their article, but it seems these findings were disappointing for all those that had hoped for so much to come of the program. Some have questioned if 10 months is too soon to evaluate the program. I am not sure what I would have expected, but I think the findings of this study should be used as a careful warning to other countries that are significantly expanding access to health insurance.
While these programs will probably do more in the long-run, short term gains might be hard to achieve – or at least demonstrate. I suspect this might be the case in Ghana, which has recently implemented national health insurance, and China which as promised a doubling of health spending in the coming years.
Health reform can be long and painful process, causing lots of headaches, costing lots of money, and may not even show immediate results on health. It is a wonder that anyone is doing it these days, but I am happy that they are….even here in the U.S…because these programs wil likely pay off in the long-run.Share on Facebook