为穷人提供公共政策? 墨西哥全民医疗保险计划的随机评估
Gary King1, Emmanuela Gakidou, Kosuke Imai
1Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA.
Lancet (London, England)
|April 11, 2009
概括
墨西哥医疗保险计划Seguro Popular在最初阶段将灾难性医疗支出减少了23%. 虽然它达到贫困人口,但它的短暂持续时间限制了对健康结果的更广泛影响.
科学领域:
- 公共卫生 公共卫生
- 卫生经济学 卫生经济学
- 社会政策 社会政策 社会政策
背景情况:
- 评估 Seguro Popular,这是一个墨西哥计划,为5000万没有保险的人提供健康保险,医疗保健,药物和设施.
- 旨在评估该计划对卫生支出和结果的影响.
研究的目的:
- 评估 Seguro Popular 计划在降低财务负担和改善健康方面的有效性.
- 评估计划对不同社会经济群体的覆盖范围和影响.
主要方法:
- 在墨西哥七个州的74个匹配的健康集群中进行随机对照试验.
- 在基线和干预后10个月调查了118,569个家庭 (n=32,515个50对).
- 治疗意图和合规者平均因果影响的估计是非参数的.
主要成果:
- 治疗意图分析显示,灾难性开支减少了23%.
- 在贫困家庭 (3.0%分) 和合规家庭 (6.5%分) 观察到灾难性支出大幅减少.
- 没有发现对药物开支,健康结果或利用的显著影响,可能是由于研究时间短.
结论:
- 人民保险成功地将资源分配给了穷人.
- 该计划的短期持续时间 (10个月) 可能对健康结果和利用有有限的可观察到的影响.
- 需要进行进一步的长期研究,以确定 Seguro Popular 的全部影响.
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