Zlatko Nikoloski (
Elias Mossialos is a professor of health policy and management at the Institute of Global Health Innovation, Imperial College London, and the Brian Abel-Smith Professor of Health Policy at the London School of Economics and Political Science.
Health Aff (Millwood). 2018 Jul;37(7):1169-1177. doi: 10.1377/hlthaff.2017.1510.
In 2004 the government of Mexico initiated an ambitious program, Seguro Popular, to extend health insurance coverage to poor and informal-sector workers. While the program had a protective effect during its early stages, its impact on out-of-pocket health spending over time is unclear. This study used two waves of the Encuesta Nacional de Salud y Nutricion (from 2006 and 2012) to analyze the protective effects of Seguro Popular and social security programs on out-of-pocket and catastrophic health spending. While, given the endogeneity of Seguro Popular enrollment, we found no link between membership and out-of-pocket health care spending in the study period, we did find a robust, albeit small, link between membership and a reduction in catastrophic health spending. A significant part of overall out-of-pocket health spending goes to purchase medications. Policy decisions are necessary to address gaps in coverage and access to medicines. Improving the quality of care as well as including more clinically effective and cost-effective medicines in the Seguro Popular package could significantly reduce out-of-pocket health care spending in Mexico.
2004 年，墨西哥政府启动了一项雄心勃勃的计划，即“大众保障”计划，旨在为贫困和非正规部门工人提供医疗保险。尽管该计划在早期阶段具有保护作用，但它对医疗支出自付部分的影响尚不清楚。本研究使用两轮“国家健康与营养调查”（2006 年和 2012 年）来分析“大众保障”计划和社会保障计划对自付和灾难性医疗支出的保护作用。虽然鉴于“大众保障”计划参保的内生性，我们在研究期间未发现参保与自付医疗费用之间存在联系，但我们确实发现参保与灾难性医疗支出减少之间存在稳健但较小的联系。自付医疗费用的很大一部分用于购买药物。需要做出政策决策来解决覆盖范围和药品获取方面的差距。提高医疗服务质量并在“大众保障”计划中纳入更多具有临床疗效和成本效益的药物，可显著降低墨西哥的自付医疗费用。
