Mexico''s Health Insurance Success Offers Lessons For US Ref

 

Wednesday, Apr 22,2009, 5:16:54 PM   Click:

America believes in major reforms of health care, it May have lessons to learn Seguro Popular, Mexico's ambitious plan to improve health care for approximately 50 million uninsured citizens, said Ryan Moore, co-author of a study published in April 8 in The Lancet, a leading International Medical Journal.

The study, conducted through a partnership between health officials from Mexico and researchers from major American universities, offers a model for U.S. policymakers could use to find scientific solutions to America itself impending crisis in health care, an experimental approach proved capable of providing answers to the objective, even the most controversial and political issues.

"If the administration has made the science involved and independent third parties, like the researchers who participated in this study, the case that the administration can do for the continuation of these programs is much higher" said Moore, an assistant professor of political science in Arts & Sciences at Washington University in St. Louis. "They are more likely to reach the truth? It is good policy and it is good science. "

The article, "Public Policy for the poor? A Randomized Evaluation of the Mexican Universal Health Insurance Program", a mass of details, two years on the ground to assess the experience of Mexico to push for better healthcare in communities ranging from villages far from urban areas to overcrowded. The study has turned dozens of Mexican communities in the real world laboratories causal effects of insurance can be empirically measured and evaluated at the household level as new services commissioned in phases in seven states in Mexico : Guerrero, Jalisco, Estado de Mexico, Morelos, Oaxaca, San Luis Potosi and the State of Sonora.


Moore and his colleagues developed the experimental design, writing, public-use software to implement it and then "tied their own hands" by the publication of a preliminary study describing exactly how the experience and analysis will be made - a process that aims to isolate the results from the fact of political interference.

Researchers have identified 74 pairs of communities who share common demographic and health, and has worked with Mexican officials to conduct household surveys capture a snapshot of each community-based health status. Then, self-employment for Mexicans, researchers randomly selected one from each pair of communities to the early introduction of the Seguro Popular, the establishment of a framework for monitoring changes in experiences of health in a community can be empirically compared to control conditions in the community correspondents.

"This is the largest randomized evaluation of health policy ever undertaken," said Moore. "We, the researchers were involved in experimental design, and responsible for data collection and analysis at the other end. Mexican officials have no control over the results and we had complete freedom to publish what we found. "

Residents of the test areas were encouraged to enroll in Seguro Popular, and the participating Mexican states received funds to improve medical facilities and improving access to health services, preventive care and medications. Tracking surveys show that the program is making a difference in its main objective, documenting a reduction of 23 percent of families in catastrophic health expenses.

"This study shows that social policy of targeting can be successful," said Moore. "If money is put into a program targeting the poor to receive health insurance, and if this program is well structured, then the poor can actually reduce the amount they pay out of pocket for care health. This May seem obvious, but it is not. Design of a targeted program in a way, in May does not mean that resources reach the people it is intended to achieve. "

In fact, the Lancet, the study identified areas where improvement needs to Seguro Popular, that he was slow to reach some residents. Surprisingly, researchers found no measurable, the first year effect on costs of medicines, health and use of health services. Ultimately, Moore said, is that without empirical objective evaluations of new programs, it is difficult to say whether the funds are spent effectively.


"This example of arm's length field testing and evaluation of social policy shows how science can contribute to improving lives of individuals," said Moore. "Much can be achieved when policy makers are willing to let science guide the evaluation process, when they are ready to submit to the possibility of being wrong. When they do, not only better public policy in the long term, but we have a larger case to make to the success of policies in the short term. "

Moore is confident the assessment model Seguro Popular may be used to guide healthcare reforms now under consideration by the Obama Administration. It reminds the State Children's Health Insurance Program, known as Schip, as an example of legislation that already includes incentives for states to experiment with funding and services. Some plans to reform Medicare encourage experimentation as a way to answer questions about what works best, both on cost and quality of care.

If America wants to be ready to make changes in its health system, the time has come for small tests. "If researchers are allowed to select these areas of testing - the scientific and statistically valid methods -? We will be able to use experimental methods to do good science, to cut through politics and get the answers we need, "said Moore." We can get the truth through these randomized experiments.