Knaul Felicia, Arreola-Ornelas Héctor, Méndez Oscar, Martínez Alejandra
Secretaría de Educación Publica, Fundación Mexicana para la Salud, México, DF, Mexico.
Salud Publica Mex. 2005;47 Suppl 1:S54-65.
To assess the impact on fair health financing and household catastrophic health expenditures of the implementation of the Popular Health Insurance (Seguro Popular de Salud).
Data analyzed in this study come from the National Income and Expenditure Household Survey (Encuesta Nacional de Ingresos y Gastos de los Hogares, ENIGH), 2000, and the National Health Insurance and Expenditure Survey, (Encuesta Nacional de Aseguramiento y Gasto en Salud, ENAGS), 2001. Estimations are based on projections of extension of the Popular Health Insurance under different conditions of coverage and out-of-pocket expenditure reductions in the uninsured population. The mathematic simulation model assumes applying the new Popular Health Insurance financial structure to the 2000 expenditure values reported by ENIGH, given the probability of affiliation by households.
The model of determinants of affiliation to the Popular Health Insurance yielded three significant variables: being in income quintiles I and II, being a female head of household, and that a household member had a medical visit in the past year. Simulation results show that important impacts on the performance of the Mexican Health System will occur in terms of fair financing and catastrophic expenditures, even before achieving the universal coverage goal in 2010. A reduction of 40% in out-of-pocket expenditures and a Popular Health Insurance coverage of 100% will decrease catastrophic health expenditures from 3.4% to 1.6%.
Our results show that the reduction of out-of-pocket expenditures generated by the new financing and health provision Popular Health Insurance model, will improve the financial fairness index and the financial contribution to the health system, and will decrease the percentage of households with catastrophic expenditures, even before reaching universal coverage. A greater impact may be expected due to coverage extension initiating in the poorest communities that have a very restricted and progressive financial contribution.
评估实施大众健康保险（Seguro Popular de Salud）对公平健康融资和家庭灾难性医疗支出的影响。
本研究分析的数据来自2000年全国家庭收入与支出调查（Encuesta Nacional de Ingresos y Gastos de los Hogares, ENIGH）以及2001年全国健康保险与支出调查（Encuesta Nacional de Aseguramiento y Gasto en Salud, ENAGS）。估计基于在不同覆盖条件和未参保人群自付费用减少情况下大众健康保险扩展情况的预测。数学模拟模型假设根据家庭参保概率，将新的大众健康保险财务结构应用于ENIGH报告的2000年支出值。
大众健康保险参保决定因素模型产生了三个显著变量：处于收入五分位数第一和第二组、为女性户主以及家庭成员在过去一年进行过医疗就诊。模拟结果表明，即使在2010年实现全民覆盖目标之前，墨西哥卫生系统在公平融资和灾难性支出方面也将产生重要影响。自付费用减少40%且大众健康保险覆盖率达到100%将使灾难性医疗支出从3.4%降至1.6%。
我们的结果表明，新的融资和医疗服务大众健康保险模式所带来的自付费用减少，将改善财务公平指数和对卫生系统的财务贡献，并将降低有灾难性支出家庭的比例，即使在未达到全民覆盖之前。由于在财务贡献非常有限且逐步递增的最贫困社区开始扩大覆盖范围，预计会产生更大影响。
