Impact of health insurance on adult mortality in rural areas: Evidence of Seguro Popular in Mexico using panel data

At the beginning of the 21st century, longstanding health inequality existing in developing countries prompted the adoption of public policies focused on increasing health insurance coverage (HIC). The adoption of these policies was based on the assumption that by expanding coverage, health outcomes of the uninsured population would improve, thus decreasing health inequalities. Yet, evidence from developing countries on the effect of HIC on health outcomes is scant. This paper contributes to this literature by studying the impact of health insurance on adult mortality in a developing country setting characterized by high income and health inequalities (Mexico). We examined Seguro Popular (SP) a public health intervention targeted towards workers in informal sector employment. We used longitudinal data from the Mexican Family Life Survey (MxFLS), a nationally representative survey of the Mexican population, that covered three important periods for the roll-out of SP: the year prior to the program’s implementation, the years of expansion, and the years when the program was approaching universal coverage. We merged SP administrative data to the MxFLS and exploited program coverage heterogeneity over time and across municipalities in the implementation of SP to examine its impact on mortality. Our findings demonstrate that SP decreased mortality among the population of adults above the age of 50 residing in rural areas with no preprogram access to medical benefits. We also showed that SP had larger effects for households not receiving benefits from Prospera, Mexico's well-known anti-poverty cash transfer program.