Association for Public Policy Analysis & Management

Mexico’s health system reform of 2003 established the System of Social Protection in Health that provided public program coverage, the Segura Popular. We use data from IPUMS-International database to compare health insurance coverage under the three major coverage schemes (Public Coverage, Social Health Insurance, and Public Employees) over three points in time - 2000, 2010 and 2015. We then use aggregate data from the World Bank and OECD to examine change in key outcomes over the same points in time. Our outcomes address two areas: (1) systems change (health care spending as percentage of GDP; number of physicians per population, births attended by skilled health staff; and out-of-pocket spending) and (2) specific health outcomes by age and sex (maternal mortality ratio, infant mortality, life expectancy by age and obesity rates). We a decrease in the percent uninsured between 2000 and 2015 (from 58.6% to 17.4%) with 98.2 million people insured in the latter year. Children age 17 and under had the greatest coverage gains. In 2000 63% of all children lacked coverage declining to only 15.4% in 2015. While the percentage of GDP devoted to health care has stayed relatively stable around 5.5%, health outcomes have generally improved. Infant mortality improved from 2.22% (22.2 per 1000 live births) in 2000 to 1.27% in 2015. Future work will attempt to isolate the impact of health system change on population outcomes using a difference-in-difference analysis assessing pre and post reform time periods.