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. FINDINGS: 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. INTERPRETATION: 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. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
OBJECTIVE: To quantify the impact of community-based health insurance (CBI) on utilization of health care services in rural Burkina Faso.
METHODS: Propensity score matching was used to minimise the observed baseline differences in the characteristics of insured and uninsured groups such that the observed difference in healthcare utilisation could generally be attributed to the CBI.
RESULTS: Compared with those who were not enrolled in the CBI, the overall increase in outpatient visits given illness in the insured group was about 40% higher, while the differential effect on utilization of inpatient care between insured and non-insured groups was insignificant. Not only were the very poor less likely to enroll in CBI, but even once insured, they were less likely to utilize health services compared to their wealthier counterparts.
CONCLUSIONS: The overall effect of CBI on health care utilization is significant and positive but the benefit of CBI is not equally enjoyed by all socioeconomic groups. The policy implications are: (a) there is a need to subsidize the premium to favor the enrolment of the very poor; and (b) various measures need to be placed in order to maximize the population's capacity to enjoy the benefits of insurance once insured.
The main goal of Seguro Popular is to improve the financial protection of the uninsured population against excessive health expenditures. Seguro Popular (SP) covers a variety of preventive and curative procedures, as well as medicines, and hospital care for the poorest segment of the Mexican population. Data: This paper estimates the impact of Seguro Popular on catastrophic health expenditures, as well as out-of-pocket health expenditures, from three different sources: National Household Survey of Income and Expenditures (ENIGH 2006); National Health and Nutrition Survey (ENSANUT 2006); and SP Impact Evaluation Survey. Methods: We first estimate naive probit models, and then compare them against bivariate probit models which use instrumental variables that take advantage of the specific SP implementation mechanisms to address the endogeneity of insurance selection choices. Results: No effect on catastrophic health expenditures is observed in the ENIGH sample. However, we find a statistically significant effect on the reduction of household’s expenditures on medicines and outpatient care. On the other hand, Seguro Popular reduces the probability of catastrophic health expenditures using the other two datasets: SP Impact Evaluation Survey, and ENSANUT. We also observe a reduction of the probability of expenditures on medicines and outpatient care among the SP insured families.
In 2003, after over 20 years of minimal health insurance coverage in rural areas, China launched a heavily subsidized voluntary health insurance program for rural residents. The authors use program and household survey data, as well as health facility census data, to analyze factors affecting enrollment into the program and to estimate its impact on households and health facilities. They obtain estimates by combining differences-in-differences with matching methods. The authors find some evidence of lower enrollment rates among poor households, holding other factors constant, and higher enrollment rates among households with chronically sick members. The household and facility data point to the scheme significantly increasing both outpatient and inpatient utilization (by 20-30 percent), but they find no impact on utilization in the poorest decile. For the sample as a whole, the authors find no statistically significant effects on average out-of-pocket spending, but they do find some-albeit weak-evidence of increased catastrophic health spending. For the poorest decile, by contrast, they find that the scheme increased average out-of-pocket spending but reduced the incidence of catastrophic health spending. They find evidence that the program has increased ownership of expensive equipment among central township health centers but had no impact on cost per case.
This paper evaluates the impact of Colombia's subsidized health insurance program (SUBS) on medical care utilization. Colombia's SUBS program is a demand-side subsidy intended for low-income families, where the screening of beneficiaries takes place in decentralized locations across the country. Due to the self-selection problems associated with non-experimental data, we implement Propensity Score Matching (PSM) methods to measure the impact of this subsidy on medical care utilization. By combining unique household survey data with community and regional data, we are able to compute propensity scores in a way that is consistent with both the local government's decision to offer the subsidy, and with the individual's decision to accept the subsidy. Although the application of PSM using these rich datasets helps to achieve a balance between the treatment and control groups along observable dimensions, we also present instrumental variable estimates to control for the potential endogeneity of program participation. Using both methods, we find that Colombia's subsidized insurance program greatly increased medical care utilization among the country's poor and uninsured. This evidence supports the case for other Latin American countries implementing similar subsidy programs for health insurance for the poor.
The authors examine the effects of the introduction of Vietnam's health insurance (VHI) program on health outcomes, health care utilization, and non-medical household consumption. The use of panel data collected before and after the insurance program's introduction allows them to eliminate any confounding effects due to selection on time-invariant un-observables, and their coupling of propensity score matching with a double-difference estimator allows them to reduce the risk of biases due to inappropriate specification of the outcome regression model. The authors'results suggest that Vietnam's health insurance program impacted favorably on height-for-age and weight-for-age of young school children, and on body mass index among adults. Their results suggest that among young children, VHI increases use of primary care facilities and leads to a substitution away from the use of pharmacists as a source of advice and non-prescribed medicines toward the use of them as a supplier of medicines prescribed by a health professional. Among older children and adults, VHI results in a marked increase in the use of hospital inpatient and outpatient departments. The results also suggest that VHI causes a reduction in annual out-of-pocket expenditures on health and an increase in non-medical household consumption, including food consumption, but mostly nonfood consumption. The authors'estimate of the VHI-induced reduction in out-of-pocket health spending is considerably smaller than their estimate of the VHI-induced increase in non-medical consumption, which is consistent with the idea that households hold back their consumption considerably if, through lack of health insurance, they are exposed to the risk of large out-of-pocket expenditures. This is especially plausible in a country where at the time (1993), a single visit to a public hospital cost on average the equivalent of 20 percent of a person's annual nonfood consumption.
Community-based health insurance is an emerging and promising concept, which addresses health care challenges faced in particular by the rural poor. The aim of this paper is to analyse whether rural Senegal members of a health insurance scheme are actually better-off than nonmembers. The results show that in poor environments, insurance programs can work: Members of les mutuelles de santeÌ (mutual health organizations) have a higher probability of using hospitalization services than nonmembers and pay substantially less when they need care. Furthermore, the analysis revealed that while the schemes achieved to attract poor people, the poorest of the poor remained excluded.
As a financing mechanism with the potential to raise additional funds for health services, whilst improving access to services amongst the poor, non-profit health insurance has become increasingly attractive to health policy-makers. Using data from a household survey in Vietnam, out of pocket health expenditure are compared between members and eligible non-members of the government-implemented voluntary health insurance scheme. Expenditures are analysed for individuals who sought care during their most recent illness. Using an endogenous dummy variable model to control for bias resulting from self-selection into the scheme, we find that health insurance reduces average out-of-pocket expenditures by approximately 200%. Whilst income inelastic, health expenditures are found to be significantly influenced by an individuals level of income, irrespective of insurance status. Despite this, insurance reduces expenditures significantly more for the poor than for the rich.
There are now some 36 million people in the world infected with HIV/AIDS. It is estimated that more than 23 million of them are economically active, including 642,000 persons in Latin America and the Caribbean. In the workplace, HIV/AIDS reduces incomes, imposes added costs on companies, and undermines fundamental labor laws due to the discrimination and rejection that infected individuals suffer. In response, the International Labor Organization (ILO) has produced a document entitled An ILO code of practice on HIV/AIDS and the world of work, which is summarized in this piece. The ILO document aims to help those in the workplace to cope with the HIV/AIDS epidemic through a set of guidelines related to: (a) preventing infection, (b) managing and reducing the impact that HIV/AIDS has on the workplace, (c) delivering care and support for infected workers and, in general, to all the people affected by this epidemic, and (d) eliminating discrimination against persons who are infected or are suspected of being infected. The ILO Code is intended to help in preparing and adopting specific measures in the workplace, thus promoting dialogue and other forms of cooperation among the government, employers, workers and their representatives, workplace health and safety officers, HIV/AIDS specialists, and other interested parties. The intention is also for the Code recommendations to be implemented and integrated with national laws, policies, and programs; company or business agreements; and workplace policies and action plans. This ILO Code is an important step in the struggle against HIV/AIDS. Aimed at governments, employers, and workers throughout the world, the Code recommendations constitute a useful tool in addressing the problem of HIV/AIDS in the workplace, in a just manner. As a "motor" of society, work cannot remain separated from issues of such great social impact.
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.
FINDINGS:
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.
INTERPRETATION:
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. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
