Grogger Jeffrey, Arnold Tamara, León Ana Sofía, Ome Alejandro
Harris School of Public Policy Studies, University of Chicago, 1155 E. 60th St, Chicago, IL 60637, Chilean Ministry of Education, Evaluation Unit, 1371 Libertador Bernardo O'Higgins Ave, Santiago, Chile, Institute of Public Policy, Business and Economics Department, Universidad Diego Portales, 797 Santa Clara Ave, Huechuraba, Santiago, Chile and NORC at the University of Chicago, 55 East Monroe Street, Chicago, IL 60603.
Health Policy Plan. 2015 Jun;30(5):593-9. doi: 10.1093/heapol/czu037. Epub 2014 Jun 12.
Low- and middle-income countries increasingly provide broad-based public health coverage to their residents. One of the goals of such programmes is to reduce the extent to which beneficiaries incur catastrophic out-of-pocket expenditures on health care. A recent field experiment showed that on average Mexico's new public insurance programme reduced such expenditures in rural areas. Our reanalysis of that data, augmented with administrative data on health infrastructure, shows that this effect depends strongly on the type of health facility to which the beneficiary has access. A second analysis, based on data from Mexico's National Household Income and Expenditure Surveys (abbreviated ENIGH for its name in Spanish), substantiates those findings. It shows that catastrophic expenditures have fallen sharply for rural households with access to well-staffed facilities, but that they have fallen little if at all for rural households with access to poorly staffed facilities. Our analysis of the ENIGH also shows that Mexico's public health insurance programme has sharply reduced catastrophic spending among urban households. Considering that most Mexicans live either in urban areas or in rural areas with access to well-staffed facilities, our results show that the public health insurance programme has been largely successful in achieving one of its key goals. At the same time, our results show how difficult it can be to provide effective protection against catastrophic health expenditures for residents of remote rural areas.
低收入和中等收入国家越来越多地为其居民提供广泛的公共卫生覆盖。此类项目的目标之一是减少受益人在医疗保健方面承担灾难性自付费用的程度。最近的一项实地实验表明，墨西哥新的公共保险项目平均减少了农村地区的此类支出。我们对该数据进行重新分析，并补充了有关卫生基础设施的行政数据，结果显示这种效果在很大程度上取决于受益人能够使用的医疗机构类型。基于墨西哥国家家庭收入和支出调查（西班牙语缩写为ENIGH）数据进行的第二项分析证实了这些发现。结果显示，能够使用人员配备良好设施的农村家庭灾难性支出大幅下降，但能够使用人员配备不足设施的农村家庭灾难性支出几乎没有下降。我们对ENIGH的分析还表明，墨西哥的公共医疗保险项目大幅减少了城市家庭的灾难性支出。鉴于大多数墨西哥人居住在城市地区或能够使用人员配备良好设施的农村地区，我们的结果表明，公共医疗保险项目在很大程度上成功实现了其关键目标之一。与此同时，我们的结果表明，为偏远农村地区居民提供有效保护以抵御灾难性医疗支出是多么困难。
