Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
Institute for Obesity Research, Tecnologico de Monterrey, Mexico.
J Glob Health. 2023 Oct 27;13:06044. doi: 10.7189/jogh.13.06044.
In 2003, the Mexican Congress approved a major reform to provide health care services to the poor population through the public insurance scheme Seguro Popular. This program was dismantled in 2019 as part of a set of health system reforms and substituted with the Health Institute for Welfare (INSABI). These changes were implemented during the initial phases of the coronavirus (COVID-19) pandemic. We aimed to examine the impact of these reforms and the COVID-19 pandemic on financial risk protection in Mexico between 2018 and 2020.
We performed a population-based analysis using cross-sectional data from the 2018 and 2020 rounds of the National Household Income and Expenditures Survey. We used a pooled fixed-effects multivariable two-stage probit model to determine the likelihood of catastrophic health expenditure (CHE), impoverishing health expenditure (IHE), and excessive health expenditure (EHE) among Mexican households. We also mapped the quintiles of changes in EHE in households without health insurance by state.
The percentage of households without health insurance almost doubled from 8.8% (three million households) in 2018 to 16.5% (5.8 million households) in 2020. We also found large increases in the proportion of households incurring in CHE (18.4%; 95% confidence interval (CI) = 6.1, 30.7) and EHE (18.7%; 95% CI = 7.9, 29.5). Significant increases in CHE, IHE, and EHE were only observed among households without health insurance (CHE: 90.7%; 95% CI = 31.6, 149.7, EHE: 73.5%; 95% CI = 25.3, 121.8). Virtually all Mexican states (n/N = 31/32) registered an increase in EHE among households without health insurance. This increase has a systematic territorial component affecting mostly central and southern states (range = -1.0% to 194.4%).
The discontinuation of the Seguro Popular Program and its substitution with INSABI during the first stages of the COVID-19 pandemic reduced the levels of health care coverage in Mexico. This reduction and the pandemic increased out-of-pocket expenditure in health and the portion of CHE and EHE in the 2018-2020 period. The effect was higher in households without health insurance and households in central and southern states of the country. Further studies are needed to determine the specific effect both of recent policy changes and of the COVID-19 pandemic on the levels of financial protection in health in Mexico.
2003 年，墨西哥国会批准了一项重大改革，通过大众保险计划 Seguro Popular 为贫困人口提供医疗服务。该计划于 2019 年作为一系列医疗系统改革的一部分被取消，并被健康福利研究所（INSABI）取代。这些变化是在冠状病毒（COVID-19）大流行的初期实施的。我们旨在研究这些改革和 COVID-19 大流行对 2018 年至 2020 年墨西哥金融风险保护的影响。
我们使用 2018 年和 2020 年全国家庭收入和支出调查的横断面数据进行了基于人群的分析。我们使用 pooled fixed-effects multivariable two-stage probit 模型来确定墨西哥家庭发生灾难性医疗支出（CHE）、致贫性医疗支出（IHE）和过度医疗支出（EHE）的可能性。我们还按各州无医疗保险家庭的 EHE 变化五分位数绘制了地图。
无医疗保险家庭的比例从 2018 年的 8.8%（300 万户）几乎翻了一番，达到 2020 年的 16.5%（580 万户）。我们还发现 CHE（18.4%；95%置信区间[CI]6.1，30.7）和 EHE（18.7%；95%CI7.9，29.5）的比例大幅上升。只有无医疗保险的家庭才会出现 CHE、IHE 和 EHE 显著增加（CHE：90.7%；95%CI31.6，149.7，EHE：73.5%；95%CI25.3，121.8）。几乎所有墨西哥州（n/N=31/32）都报告了无医疗保险家庭的 EHE 增加。这种增加具有系统的地域成分，主要影响中南部各州（范围-1.0%至 194.4%）。
在 COVID-19 大流行的初期，Seguro Popular 计划的停止及其被 INSABI 取代降低了墨西哥的医疗保健覆盖率。这种减少以及大流行增加了 2018-2020 年期间的医疗保健自付支出和 CHE 和 EHE 的比例。在没有医疗保险的家庭和该国中南部各州的家庭中，这种影响更高。需要进一步研究来确定最近政策变化和 COVID-19 大流行对墨西哥健康金融保护水平的具体影响。
