The effects of public health insurance in labor markets with informal jobs: Evidence from Mexico

Impact of urban-rural resident basic medical insurance on consumption quality of middle-aged and older adult residents: evidence from rural China

In the context of the Chinese government's advocacy for "Internal Circulation", ongoing reforms in medical insurance policies raise critical questions about whether the basic medical insurance system can stimulate resident consumption and enhance its quality. Based on five waves of panel data from the China Health and Retirement Longitudinal Survey (CHARLS), this paper analyzes the impact of medical insurance on the consumption scale and structure of middle-aged and older adult rural residents by using the time-varying difference-in-differences (time-varying DID) method. The findings indicate that the Urban-Rural Resident Basic Medical Insurance (URRBMI) effectively stimulates the consumption scale of rural middle-aged and older adult individuals, particularly enhancing non-food consumption, development-oriented spending, and hedonic consumption. This, in turn, optimizes the consumption structure and improves overall consumption quality. Notably, URRBMI significantly enhances the consumption scale and structure among rural middle-aged and older adult women, unmarried individuals, and residents in western China. These results suggest that URRBMI plays a crucial role in alleviating consumption inequality within rural areas and across different regions, providing a theoretical foundation for policy-making.

The Impact of Seguro Popular on the Progression of Disabilities Among Older Adults With Chronic Degenerative Diseases in Mexico

In a context of population aging, poverty, and inequalities including in the access to healthcare services, in 2004 Mexico initiated Seguro Popular (SP), a non-contributory health insurance providing coverage for informal sector workers excluded from social security. We analyze the impact of SP on the progression of functional limitations among adults aged over 50 with chronic degenerative diseases previously without stable health insurance. Panel data from the Mexican Health and Aging Study (MHAS) permit a difference-in-difference propensity score matching approach, comparing respondents before (2003) and after (2015) the implementation of SP. Findings suggest that SP affiliation in (or shortly before) 2012 has (weakly) slowed the progression of mobility, IADL, and ADL limitations, with a clearer effect in large urban centers. Reforms in the healthcare sector should address underlying structural barriers, reduce existing inequities, and provide effective access to high-quality services. with increased attention for long-term care needs, to guarantee healthy aging.

Effective access to health care in Mexico

OBJECTIVES

This paper assesses the impact of effective access on out-of-pocket health payments and catastrophic health expenditure. Effective access cannot be attained unless both health services and financial risk protection are accessible, affordable, and acceptable. Therefore, it represents a key determinant in the transition from fragmented health systems to universal coverage that many low- and middle-income countries face.

METHODS

We use a definition of effective access as the utilization of health insurance when available. We conducted a cross-sectional analysis using the 2018 Mexican National Health Survey (ENSANUT) at the household level. The analysis is performed in two stages. The first stage is a multinomial analysis that captures the factor associated with choosing effective access against the alternative of paying privately. The second stage consists of an impact analysis regarding the decision of not choosing effective access in terms of out-of-pocket (OOP) health payments and catastrophic health expenditures (CHE). The analysis corrects for both the decision to buy insurance and the decision to pay for health care.

RESULTS

We found that, on average, not choosing effective access increases OOP health payments by around 2300 pesos annually. Medicine payments are the most common factor in this increase. Nevertheless, outpatient and medicines health care are the main drivers of the increase in OOP health payments in all insurance beneficiaries. Not having effective access increases the probability of CHE health expenditures by 2.7 p.p. for the case of Social Security Insurance and 4.0 p.p. for Social Government insurance. Household enrolled in Prospera program for the poor are more likely to choose effective access while having household heads with more education and assets value does the opposite. Diabetes illnesses are associated with a higher probability of effective access.

CONCLUSION

Improving effective access is a middle step that cannot be disregarded when seeking universal coverage because OOP health payments and catastrophic outcomes are direct consequences. Public insurance in general, has around 50% effective access which remains a challenge in terms of health services utilization and health public policy design, calling for the need of better coordination across insurance types and pooling mechanisms to increase sustainability of needed health services.

Time Use of Youth during a Pandemic: Evidence from Mexico

Studying how the pandemic affects the education and work of adolescents is a critical question with long lasting implications for well-being of the next generation, particularly in the developing world. The Covid-19 pandemic by mid-March 2020 had led to the closing of most educational institutions in Latin America and the Caribbean, and the region has been one of the worst hit by the pandemic (Sanmarchi et al. 2021). This paper uses the Mexican National Occupation and Employment Survey (ENOE) to provide initial evidence on the pandemic's effects on school and work of youth. We measure changes in the time use of adolescents comparing patterns just before the pandemic (January to March 2020) with those at the beginning of the following school year (September 2020), controlling for pre pandemic trends and potential seasonality. Our study finds a sharp reduction in the probability of being engaged in studies during the previous week for youth age 12 to 18 during the pandemic, as well as a reduction of about 30 percent in total hours spent on studies for those who report spending at least one hour on studies in the previous week. Time in work in general shows fewer changes than in time dedicated to studies, with some reductions in the probability of working outside the home for older youth, and a small increase in the number of hours dedicated to work inside the household. Our results overall are suggestive of an important decrease in youth who are engaged with school, who may be at particular risk for abandoning school permanently. It also suggests that even for those who remain engaged, there is a reduction on time spent studying likely to lead to a decrease in learning. Policies to combat potential dropout and negative effects on learning of the pandemic are urgently needed.