A Gender-Based and Quasi-Experimental Study of the Catastrophic and Impoverishing Health-Care Expenditures in Mexican Households with Elderly Members, 2000-2020

Serván‐Mori, Edson; Orozco, Emanuel; Guerrero-López, Carlos Manuel; Miranda, J. Jaime; Jan, Stephen; Downey, Laura; Feeny, Emma; Heredia-Pi, Ileana; Flamand, Laura; Nigenda, Gustavo; Norton, Robyn

doi:10.1080/23288604.2023.2183552

Cited by 7 publications

(9 citation statements)

References 45 publications

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“…Following previous studies [ 29 , 37 - 43 ], we included several characteristics in our multivariate analysis at different levels: head of household: age (in years), sex (women = 1, men = 0), schooling level (none, elementary, secondary, high school, and college), employment during the last month (yes = 1, no = 0), and marital status (married/free union, divorced/separated/widowed, and single). Household characteristics: indigenous status (yes = 1, no = 0), composition (unipersonal, nuclear, extended, or composited), number of equivalent adults [ 44 ], the proportion of family members aged 0-5 or ≥65 years and with a disability, a factorial asset and housing material standardised index as a measure of socioeconomic status [ 45 ], where the higher values indicate a greater number of assets and better housing conditions, and participation in any government conditional/non-conditional transfers program.…”

Section: Methodsmentioning

confidence: 89%

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Increase of catastrophic and impoverishing health expenditures in Mexico associated to policy changes and the COVID-19 pandemic

Serván-Mori,

Gómez-Dantés,

Contreras

et al. 2023

J Glob Health

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Background 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. Methods 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. Results 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%). Conclusions 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.

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Section: Methodsmentioning

confidence: 89%

“…The results of this study have some limitations. First, although the estimated models considered an exhaustive set of predictors for the outcomes of interest [ 29 , 37 - 43 ], this analysis is subject to the limitations of any observational study (i.e. biases due to omitted variables).…”

Section: Discussionmentioning

confidence: 99%

Increase of catastrophic and impoverishing health expenditures in Mexico associated to policy changes and the COVID-19 pandemic

Serván-Mori,

Gómez-Dantés,

Contreras

et al. 2023

J Glob Health

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“…Therefore, prompt recognition of chronic conditions and targeted surveillance and screening of diseases with high prevalence rates will markedly decelerate the advancement of chronic illnesses, diminish the occurrence of terminal conditions, curtail healthcare expenses and considerably augment the standard of living of patients. 6 , 7 …”

Section: Introductionmentioning

confidence: 99%

Epidemiological Characterisation of Chronic Diseases Among Civil Servants in Hebei Province, China: A Cross-Sectional Real-World Study of Approximately 50,000 Adults

Pan,

Wang,

Jia

et al. 2024

RMHP

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Background The objective of this investigation was to explore the health status and epidemiological features of civil servants working in Hebei Province, China. Methods Data was collected through a cross-sectional survey that involved 50,039 adult civil servants in Hebei Province. The research was conducted at the Hebei Provincial Medical Examination Centre and included inquiries about demographics, health behaviours, chronic illnesses, and abnormal check-up indicators. Statistical data were used to determine the prevalence of chronic diseases and abnormal health examination indicators. Subgroup analyses by sex were then conducted to calculate the similarities and differences in health status between men and women. Results The findings of the survey indicate that 14.2% of individuals who work in civil service suffer from obesity. Additionally, a considerable proportion of this group display poor health behaviours, including smoking and alcohol consumption. Hypertension (21.03%), dyslipidaemia (10.88%), and diabetes mellitus (8.56%) were identified as the top three chronic diseases, while cardiovascular diseases were prevalent at 6.27% among civil servants. Ultrasound showed a high prevalence of fatty liver, non-smooth gallbladder and liver cysts (44.61%, 33.24% and 23.26% respectively). The occurrence of pulmonary nodules was alarmingly high at 88.48%, while thyroid nodules were found in as much as 62.65% of patients. Abnormal E/A values≤1, prostate hyperplasia, breast nodules, and carotid plaques were also prevalent, with percentages ranging from 46.76% to 63.04%. In subgroup analyses by gender, the prevalence of chronic diseases and abnormal screening indicators was consistently higher in men than in women, with the exception of thyroid nodules and thyroid surgery. Conclusion The survey revealed a large proportion of civil servants in Hebei Province, China, suffering from chronic diseases, underscoring the necessity for enhanced attention to chronic disease prevention and management in this group and emphasising the requirement for focused interventions aimed at improving health outcomes.

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“…Other studies have looked at single countries, examined COVID-19 care spending, or only assessed OOP spending (but not CHE). 4 , 6 , 7 , 11 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 The absence of cross-country comparison of 2020 CHE limits understanding of health system resilience and the adaptation of policies to address financial hardship going forward.…”

Section: Introductionmentioning

confidence: 99%

Catastrophic health expenditure during the COVID-19 pandemic in five countries: a time-series analysis

Haakenstad,

Bintz,

Knight

et al. 2023

The Lancet Global Health

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A Gender-Based and Quasi-Experimental Study of the Catastrophic and Impoverishing Health-Care Expenditures in Mexican Households with Elderly Members, 2000-2020

Cited by 7 publications

References 45 publications

Increase of catastrophic and impoverishing health expenditures in Mexico associated to policy changes and the COVID-19 pandemic

Increase of catastrophic and impoverishing health expenditures in Mexico associated to policy changes and the COVID-19 pandemic

Epidemiological Characterisation of Chronic Diseases Among Civil Servants in Hebei Province, China: A Cross-Sectional Real-World Study of Approximately 50,000 Adults

Catastrophic health expenditure during the COVID-19 pandemic in five countries: a time-series analysis

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