Assessing horizontal equity in medication treatment among elderly Mexicans: which socioeconomic determinants matter most?

Abstract

Many low-and middle-income countries are currently undergoing a dramatic epidemiological transition, with an increasing disease burden due to degenerative noncommunicable diseases. Inexpensive medication treatment often represents a cost-effective means to prevent, control or cure many of these health conditions. Using micro data from the 2001 Mexican Health and Aging Study, we assess horizontal inequity in medication treatment among older Mexicans before the introduction of Popular Health Insurance in Mexico. In doing so, we investigate the role of various dimensions of socioeconomic status for obtaining indicated medication treatment within a comparatively fragmented health care system that features relatively high out-of-pocket expenditures. Our empirical analysis suggests health insurance coverage as a key socioeconomic determinant of indicated medication use with large and statistically significant positive effects on take-up. The effects of insurance status thereby clearly dominate any other possible effects of socioeconomic status on medication treatment. Our results thus highlight the importance of access to reliable health care and comprehensive coverage for rational medication use in the management of degenerative diseases. In light of this evidence, we expect that recent Mexican health care reforms, which expand health insurance coverage to the previously uninsured population, will alleviate socioeconomic gradients in medication treatment among older people in need.Keywords: Medication Treatment, Socioeconomic Status, Equity, Mexico * Mannheim Research Institute for the Economics of Aging (MEA), University of Mannheim, L13, 17, 68131 Mannheim, Germany. Email: juergen.maurer@iue.it. I am deeply grateful to Emma Aguila, Emily Sinnott and seminar participant at the MEA and the UNU WIDER conference on "Advancing Health Equity" for valuable comments and suggestions. Remaining errors are, of course, my own responsibility.

Active pharmaceutical management strategies of health insurance systems to improve cost-effective use of medicines in low- and middle-income countries: A systematic review of current evidence

“…Several studies have shown that being insured was associated with an increased use of medicines [25,[28][29][30][31][32], and one found that insurance is a key determinant in the use of medicines [29]. Insurance has been associated with increased percentage of prescriptions actually filled [27,33], decreased probability of gaps in medicines treatment [29], increased utilization of chronic disease medicines [32], and increased adherence to a prescribed regimen [34]. Studies in Mexico found that insured diabetics had more insulin injections per week and a higher probability of having blood glucose controlled [35], while hypertensive patients had an increased probability of receiving antihypertensive treatment and having blood pressure controlled [36].…”

Access to healthcare and financial risk protection for older adults in Mexico: secondary data analysis of a national survey

“…The socioeconomic conditions and availability of health insurance (HI) for older adults are major determinants of the differential use of health services and access to medicines. 4 5 From this standpoint, the Mexican population can be divided into three main groups: those affiliated with SS; those affiliated with Seguro Popular (SP); and those who do not have any HI. The right to SS is linked to employment status.…”

Confronting The Chronic Disease Burden In Latin America And The Caribbean

“…27 Studies in Mexico indicate that public subsidies via insurance have a significant impact on access to medications for hypertension and diabetes by the elderly. 28 They also show that a conditional cash transfer program, which conditions monthly monetary transfers to poor adults on use of preventive health care twice a year, has improved measures of adult health and reduced risk-factor prevalence. 29 Address Provider Incentives Aligning incentives for provider performance holds promise.…”