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The Impact of Universal Health Insurance on Catastrophic and Out-of-Pocket Health Expenditures in Mexico: a Model with an Endogoenous Treatment Variable


  • Galarrága, O
  • Sosa-Rubí, S. G
  • Salinas, A
  • Sesma, S


The main goal of Seguro Popular is to improve the financial protection of the uninsured population against excessive health expenditures. Seguro Popular (SP) covers a variety of preventive and curative procedures, as well as medicines, and hospital care for the poorest segment of the Mexican population. Data: This paper estimates the impact of Seguro Popular on catastrophic health expenditures, as well as out-of-pocket health expenditures, from three different sources: National Household Survey of Income and Expenditures (ENIGH 2006); National Health and Nutrition Survey (ENSANUT 2006); and SP Impact Evaluation Survey. Methods: We first estimate naive probit models, and then compare them against bivariate probit models which use instrumental variables that take advantage of the specific SP implementation mechanisms to address the endogeneity of insurance selection choices. Results: No effect on catastrophic health expenditures is observed in the ENIGH sample. However, we find a statistically significant effect on the reduction of household’s expenditures on medicines and outpatient care. On the other hand, Seguro Popular reduces the probability of catastrophic health expenditures using the other two datasets: SP Impact Evaluation Survey, and ENSANUT. We also observe a reduction of the probability of expenditures on medicines and outpatient care among the SP insured families.

Suggested Citation

  • Galarrága, O & Sosa-Rubí, S. G & Salinas, A & Sesma, S, 2008. "The Impact of Universal Health Insurance on Catastrophic and Out-of-Pocket Health Expenditures in Mexico: a Model with an Endogoenous Treatment Variable," Health, Econometrics and Data Group (HEDG) Working Papers 08/12, HEDG, c/o Department of Economics, University of York.
  • Handle: RePEc:yor:hectdg:08/12

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    Cited by:

    1. Pantig, Ida Marie T., 2015. "Sustainability of the National Government Premium Subsidy for Indigents," Philippine Journal of Development PJD 2013 Vol. 40 Nos. 1-2, Philippine Institute for Development Studies.
    2. Sparrow, Robert & Suryahadi, Asep & Widyanti, Wenefrida, 2013. "Social health insurance for the poor: Targeting and impact of Indonesia's Askeskin programme," Social Science & Medicine, Elsevier, vol. 96(C), pages 264-271.

    More about this item


    catastrophic health expenditures; health insurance; instrumental variables; non-linear methods; Mexico;

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs

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