Assessing Universal Coverage: Mexico’s Seguro Popular

In the second half of the 20th century, a series of reforms in Mexico’s health system with the goal of expanding coverage gave rise to Seguro Popular de Salud, or Popular Insurance, a financial protection mechanism designed to guarantee the right for healthcare for every citizen. The intention of Seguro Popular was to expand access to health services for over 50 million uninsured individuals by eliminating out-of-pocket health payments with the ultimate aim to improve the population’s health.
The objective of this thesis is to assess the impact of Seguro Popular on health outcomes, healthcare access, inequality and financial protection. The first chapter introduces the study and describes the programme. The second chapter is an assessment of the impact of Seguro Popular on Mexican population’s health status and on utilisation of healthcare. Exploiting the time and space variation in the introduction of Seguro Popular, treatment effects are estimated using difference-in- differences specifications with variations in identification strategies. Results show that the programme had significant effects on reducing infant mortality rates. However, there were no clear effects on the adult health outcomes examined and on healthcare utilisation.
The aim of the third chapter is to find the effect of Seguro Popular on children’s nutritional status; and to estimate the change in pure health inequality derived from the programme. Taking advantage of the staggered roll-out of Seguro Popular, children’s height-for-age z-scores are assessed using a changes-in-changes approach. Results show that of Seguro Popular had a slightly positive effect on children’s height. Moreover, the benefits were marginally larger for children in the lowest tail of the height distribution which represents a reduction of pure inequality in health.
The fourth chapter is an assessment of the antipoverty effect of Seguro Popular. Using instrumental variables, this study presents local average treatment effects of Seguro Popular on out-of-pocket healthcare expenditures, catastrophic expenditures and impoverishing. Results show a small reduction in out-of-pocket healthcare payments, although no clear effect on catastrophic payments or on impoverishing. However, the programme slightly reduced poverty overall and had a positive effect on households’ welfare.