Replication data for: Public Policy for the Poor? A Randomised Assessment of the Mexican Universal Health Insurance Programme

Background: We assessed aspects of Seguro Popular, a programme aimed to deliver health insurance, regular and preventive medical care, medicines, and health facilities to 50 million uninsured Mexicans. Methods: We randomly assigned treatment within 74 matched pairs of health clusters–-i.e., health facility catchment areas–-representing 118,569 households in seven Mexican states, and measured outcomes in a 2005 baseline survey (August 2005, to September 2005) and follow-up survey 10 months later (July 2006, to August 2006) in 50 pairs (n=32 515). The treatment consisted of encouragement to enrol in a health-insurance programme and upgraded medical facilities. Participant states also received funds to improve health facilities and to provide medications for services in treated clusters. We estimated intention to treat and complier average causal effects non-parametrically. Findings: Intention-to-treat estimates indicated a 23% reduction from baseline in catastrophic expenditures (1·9% points and 95% CI 0·14-3·66). The effect in poor households was 3·0% points (0·46-5·54) and in experimental compliers was 6·5% points (1·65-11·28), 30% and 59% reductions, respectively. The intention-to-treat effect on health spending in poor households was 426 pesos (39-812), and the complier average causal effect was 915 pesos (147-1684). Contrary to expectations and previou s observational research, we found no effects on medication spending, health outcomes, or utilisation. Interpretation: Programme resources reached the poor. However, the programme did not show some other effects, possibly due to the short duration of treatment (10 months). Although Seguro Popular seems to be successful at this early stage, further experiments and follow-up studies, with longer assessment periods, are needed to ascertain the long-term effects of the programme. See also: Mexican Health Care Evaluation

背景：本研究评估了《大众保险计划》（Seguro Popular）的相关维度，该计划旨在为5000万未参保墨西哥民众提供健康保险、常规与预防性医疗服务、药品及医疗设施。方法：我们在74组匹配的医疗集群——即医疗机构服务覆盖区域——内开展随机分组干预，这些集群涵盖墨西哥7个州的118569户家庭，并于2005年基线调查（2005年8月至9月）以及10个月后的随访调查（2006年7月至8月）中，对其中50组集群（n=32515）的结局指标进行测量。本次干预包含鼓励参保健康保险计划以及升级医疗设施两项内容。参与本研究的各州还获得了专项资金，用于改善医疗设施并为干预集群内的医疗服务提供药品。我们采用非参数方法估计了意向治疗（intention-to-treat, ITT）效应与依从者平均因果效应（complier average causal effect, CACE）。结果：意向治疗效应估计显示，灾难性医疗支出较基线水平降低23%（1.9个百分点，95%置信区间CI：0.14~3.66）。贫困家庭的干预效应为3.0个百分点（95%CI：0.46~5.54），实验依从者的干预效应为6.5个百分点（95%CI：1.65~11.28），对应分别实现30%与59%的支出降幅。意向治疗效应对贫困家庭的医疗支出影响为426比索（95%CI：39~812），依从者平均因果效应为915比索（95%CI：147~1684）。与预期及既往观察性研究相悖的是，本研究未发现该计划对药品支出、健康结局或医疗服务利用产生任何显著影响。解读：该计划的资源确实惠及了贫困群体。然而，该计划并未展现出其他预期效应，这可能缘于干预周期仅为10个月。尽管《大众保险计划》在当前早期阶段看似成效显著，但仍需开展周期更长的后续实验与追踪研究，以明确该计划的长期效应。另见：墨西哥医疗保健评估（Mexican Health Care Evaluation）