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Heterogeneous Impact of the "Seguro Popular" Program on the Utilization of Obstetrical Services in Mexico, 2001-2006: A Multinomial Probit Model with a Discrete Endogenous Variable

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  • Sandra G. Sosa-Rubi
  • Omar Galarraga
  • Jeffrey E. Harris

Abstract

Objective: We evaluated the impact of Seguro Popular (SP), a program introduced in 2001 in Mexico primarily to finance health care for the poor. We studied the effect of SP on pregnant women's access to obstetrical services. Data: We analyzed the cross-sectional 2006 National Health and Nutrition Survey (ENSANUT), focusing on the responses of 3,890 women who delivered babies during 2001-2006 and whose households lacked employer-based health care coverage. Methods: We formulated a multinomial probit model that distinguished between three mutually exclusive sites for delivering a baby: a health unit accredited by SP; a clinic run by the Department of Health (Secretaria de Salud, or SSA); and private obstetrical care. Our model accounted for the endogeneity of the household's binary decision to enroll in the SP program. Results: Women in households that participated in the SP program had a much stronger preference for having a baby in a SP-sponsored unit rather than paying out of pocket for a private delivery. At the same time, participation in SP was associated with a stronger preference for delivering in the private sector rather than at a state-run SSA clinic. On balance, the Seguro Popular program reduced pregnant women's attendance at an SSA clinic much more than it reduced the probability of delivering a baby in the private sector. The impacts of the SP program at the individual and population levels varied with the woman's education and health, as well as the assets and location (rural versus urban) of the household. Conclusions: The SP program had a robust, significantly positive impact on access to obstetrical services. Our finding that women enrolled in SP switched from non-SP state-run facilities, rather than from out-of-pocket private services, is important for public policy and requires further exploration.

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Bibliographic Info

Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 13498.

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Date of creation: Oct 2007
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Publication status: published as Sosa-Rubí, Sandra G. & Galárraga, Omar & Harris, Jeffrey E., 2009. "Heterogeneous impact of the "Seguro Popular" program on the utilization of obstetrical services in Mexico, 2001-2006: A multinomial probit model with a discrete endogenous variable," Journal of Health Economics, Elsevier, vol. 28(1), pages 20-34, January.
Handle: RePEc:nbr:nberwo:13498

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Cited by:
  1. Reyes Aterido & Mary Hallward-Driemeier & Carmen Pagés-Serra, 2011. "Does Expanding Health Insurance Beyond Formal-Sector Workers Encourage Informality?: Measuring the Impact of Mexico's Seguro Popular," IDB Publications 81001, Inter-American Development Bank.
  2. Bernal, Noelia & Carpio, Miguel A. & Klein, Tobias J., 2014. "The Effects of Access to Health Insurance for Informally Employed Individuals in Peru," IZA Discussion Papers 8213, Institute for the Study of Labor (IZA).
  3. Lyssenko, Nikita & Martinez-Espineira, Roberto, 2009. "`Been there done that': Disentangling option value effects from user heterogeneity when valuing natural resources with a use component," MPRA Paper 21976, University Library of Munich, Germany, revised 08 Apr 2010.
  4. Acharya, Arnab & Vellakkal, Sukumar & Taylor Fiona & Masset Edoardo & Satija, Ambika & Burke, Margaret & Ebrahim, Shah, 2013. "The impact of health insurance schemes for the informal sector in low- and middle-income countries : a systematic review," Policy Research Working Paper Series 6324, The World Bank.
  5. Garcia-Diaz, Rocio & Sosa-Rub, Sandra G., 2011. "Analysis of the distributional impact of out-of-pocket health payments: Evidence from a public health insurance program for the poor in Mexico," Journal of Health Economics, Elsevier, vol. 30(4), pages 707-718, July.
  6. Spenkuch, Jörg L., 2012. "Moral hazard and selection among the poor: Evidence from a randomized experiment," Journal of Health Economics, Elsevier, vol. 31(1), pages 72-85.

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