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首页> 外文期刊>Journal of health economics >Heterogeneous Impact Of The 'seguro Popular' Program On The Utilization Of Obstetrical Services In Mexico, 2001-2006: A Multinomial Probit Model With A Discrete Endogenous Variable
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Heterogeneous Impact Of The 'seguro Popular' Program On The Utilization Of Obstetrical Services In Mexico, 2001-2006: A Multinomial Probit Model With A Discrete Endogenous Variable

机译：2001-2006年“ seguro Popular”计划对墨西哥产科服务利用的异质影响：带有离散内生变量的多项式概率模型

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Objective: We evaluated the impact of Seguro Popular (SP), a program introduced in 2001 in Mexico primarily to finance health care for the poor. We focused on the effect of household enrollment in SP on pregnant women's access to obstetrical services, an important outcome measure of both maternal and infant health. Data: We relied upon data from the cross-sectional 2006 National Health and Nutrition Survey (ENSANUT) in Mexico. We analyzed the responses of 3890 women who delivered babies during 2001-2006 and whose households lacked employer-based health care coverage. Methods: We formulated a multinomial probit model that distinguished between three mutually exclusive sites for delivering a baby: a health unit specifically accredited by SP; a non-SP-accredited clinic run by the Department of Health (Secretaria de Salud, or SSA); and private obstetrical care. Our model accounted for the endogeneity of the household's binary decision to enroll in the SP program. Results: Women in households that participated in the SP program had a much stronger preference for having a baby in a SP-sponsored unit rather than paying out of pocket for a private delivery. At the same time, participation in SP was associated with a stronger preference for delivering in the private sector rather than at a state-run SSA clinic. On balance, the Seguro Popular program reduced pregnant women's attendance at an SSA clinic much more than it reduced the probability of delivering a baby in the private sector. The quantitative impact of the SP program varied with the woman's education and health, as well as the assets and location (rural vs. urban) of the household. Conclusions: The SP program had a robust, significantly positive impact on access to obstetrical services. Our finding that women enrolled in SP switched from non-SP state-run facilities, rather than from out-of-pocket private Services, is important for public policy and requires further exploration.
机译：目的：我们评估了Seguro Popular（SP）的影响，该计划于2001年在墨西哥推出，主要用于资助穷人的医疗保健。我们集中研究了SP入户对孕妇获得产科服务的影响，这是衡量母婴健康状况的重要结果。数据：我们采用了墨西哥2006年全国健康与营养调查（ENSANUT）横断面的数据。我们分析了2001年至2006年间分娩的3890名妇女的回答，这些妇女的家庭缺乏雇主提供的医疗保险。方法：我们制定了多项式概率模型，该模型区分了三个互相排斥的分娩地点：SP专门授权的卫生部门；由卫生部（Secretaria de Salud或SSA）运营的未经SP认可的诊所；和私人产科护理。我们的模型考虑了家庭加入SP计划的二元决策的内生性。结果：参加SP计划的家庭中的妇女更愿意在SP赞助的单位中生孩子，而不是为私人分娩而自掏腰包。同时，参与SP与在私营部门而不是在国有的SSA诊所中提供医疗服务的偏好更大。总体而言，Seguro Popular计划减少了孕妇在SSA诊所就诊的机会，远不止于减少了在私营部门分娩婴儿的可能性。 SP计划的量化影响随妇女的教育和健康状况以及家庭的资产和位置（农村还是城市）而异。结论：SP计划对获得产科服务具有强大而显着的积极影响。我们的发现表明，加入SP的妇女从非SP的国营机构转而选择了自付费用的私人服务机构，这对于公共政策很重要，需要进一步探索。

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