Association for Public Policy Analysis & Management

Addressing major health needs is a worldwide challenge, which many countries struggle to meet (Peters et al. 2009). Reaching vulnerable populations is a particular priority in developing areas. With this goal in mind, the Secretary of Health of Mexico City adopted an innovative program called Doctor at Your Home (Médico en Tu Casa) in 2014, designed to reach underserved patients by providing care in their homes, rather than expecting them to come to health centers. Originally, the program targeted only pregnant women in order to address increasing maternal death rates in Mexico City. Through this program, physicians visited households looking for pregnant women without prenatal care. Once the program identifies a pregnant woman without prenatal care, a physician evaluates her status and refers her to appropriate care. Doctor at Your Home implementers found 31 percent of pregnant women in the city did not receive prenatal care. From this amount, 40 percent had a high-risk pregnancy. This paper evaluates the impact of this intervention on three health outcomes associated with prenatal care: prematurity, infant mortality rate, and low birth weight. To do this, I take advantage of the program’s roll out. I use the fact that the stage of the pregnancy at which the program identifies the women is uncorrelated to any confounding factors affecting both the stage of the pregnancy and the health outcomes of interest. This study aims to shed light on health policy interventions that could be employed to increase access to prenatal care.