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.

The roll-out of a health insurance program and its impact on the supply of healthcare services: a new method to evaluate time-varying continuous interventions.

BACKGROUND: We analyze the effects of the Mexican universal health insurance program, Seguro Popular, on key variables associated with the provision of healthcare services. Given that the program was introduced gradually over a period that lasted more than a decade, the dynamics of the roll-out of the program and its reaction to the expansion of healthcare services it caused should be accounted for when evaluating the program. METHODS: We present a new semiparametric procedure to analyze time-varying continuous interventions. This is accomplished by bringing together the literatures on continuous and on dynamic treatments. Our approach allows the researcher to estimate mean and quantile dose-response functions by applying local regression methods to appropriately weighted samples that control for time-dependent confounding. RESULTS: Using administrative data, we show compelling evidence that Seguro Popular has incremented the human and physical resources available for healthcare services over the period 2001-2013. Moreover, we show that these effects have been heterogeneously distributed. CONCLUSIONS: The program has proven most helpful in less vulnerable territories, leaving behind those in greater need.

Precautionary Savings in Mexico: Evidence from the Mexican Health and Aging Study.

Precautionary saving is the additional saving done by individuals to protect them financially in situations of uncertainty and reduce their vulnerability for negative shocks that may affect their consumption levels. This paper investigates the existence and extent of savings motivated by precaution in Mexico for people aged between 50 and 75, using data from the Mexican Health and Ageing Study 2003. The empirical strategy is based on a test of the direct relationship between the accumulated wealth and the uncertainty generated by the social security status, in particular the availability of health insurance, accounting also for the expectation to receive a retirement pension. The endogeneity-corrected estimates do not yield results that unequivocally support the existence of private savings as a risk protection mechanism, implying that the public protection system has an important role in reducing the vulnerability of the population studied.

[Unemployment and mental health among Hispanics in the US: an epidemiological analysis]. / Desempleo y salud mental en la población de origen hispano en Estados Unidos: un análisis epidemiológico.

The high unemployment rates observed in the United States during the recent economic crisis, that moreover vary between ethnic groups, make it relevant to inquire into how this problem is linked to the mental health of employed and unemployed persons. Therefore, in this paper the relationship between unemployment and mental health among Mexican immigrants, Mexicans born in the US, and other Hispanics in comparison with non-Hispanic native whites and Afro-Americans in the US is analyzed. To achieve this objective prevalence, prevalence ratios and odds ratios for the population between 18 and 65 years of age in the labor force was calculated using data from the 1999 and 2009 National Health Interview Surveys. It was seen that in times of crisis the prevalence of Non-Specific Psychological Disorders (NSPD) in the labor force increased in all ethnic groups. The prevalence ratios indicate that the unemployed face a higher risk of suffering from NSPD than the employed, especially for the non-Mexican Hispanics. Mexican immigrants, in contrast, show the lowest risks.

Desempleo y salud mental en la población de origen hispano en Estados Unidos: un análisis epidemiológico / Unemployment and mental health among Hispanics in the US: an epidemiological analysis

Resumen Las altas tasas desempleo observadas en Estados Unidos durante la reciente crisis económica, que además son diferenciadas de acuerdo al origen étnico, hacen pertinente indagar acerca de cómo este problema se relaciona con la salud mental de los empleados y desempleados. Por tanto, en este artículo analizamos la relación entre desempleo y salud mental de los inmigrantes mexicanos, mexicanos nacidos en EE.UU, y otros hispanos en comparación con nativos blancos no hispanos y afroestadounidenses. Para alcanzar este propósito calculamos prevalencias, razones de prevalencias y razones de momios en la población entre 18 y 65 años en la fuerza laboral. Utilizamos información de la National Health Interview Survey (1999 y 2009). Encontramos que en tiempos de crisis aumenta la prevalencia de Tensión Psicológica no Específica (TPNE) en la fuerza laboral para todos los grupos étnicos. Las razones de prevalencias indican que los desempleados tienen mayor riesgo de presentar una TPNE que los empleados, particularmente los hispanos no mexicanos, en contraste, los inmigrantes mexicanos muestran riesgos más bajos.

Abstract The high unemployment rates observed in the United States during the recent economic crisis, that moreover vary between ethnic groups, make it relevant to inquire into how this problem is linked to the mental health of employed and unemployed persons. Therefore, in this paper the relationship between unemployment and mental health among Mexican immigrants, Mexicans born in the US, and other Hispanics in comparison with non-Hispanic native whites and Afro-Americans in the US is analyzed. To achieve this objective prevalence, prevalence ratios and odds ratios for the population between 18 and 65 years of age in the labor force was calculated using data from the 1999 and 2009 National Health Interview Surveys. It was seen that in times of crisis the prevalence of Non-Specific Psychological Disorders (NSPD) in the labor force increased in all ethnic groups. The prevalence ratios indicate that the unemployed face a higher risk of suffering from NSPD than the employed, especially for the non-Mexican Hispanics. Mexican immigrants, in contrast, show the lowest risks.

WORKING AND CARING: THE SIMULTANEOUS DECISION OF LABOR FORCE PARTICIPATION AND INFORMAL ELDERLY AND CHILD SUPPORT ACT IVITIES IN MEXICO.

We analyze factors determining women's decisions to participate in the labor market and provide elderly care and nonfinancial support to their (grand)children. We use data from the Mexican Health and Aging Study, a survey of people aged 50 and over, applying a three-equation, reduced-form SUR model. Results suggest that care needs are the driving force behind caregiving activities. Traditional roles also appear to be relevant in the labor force participation decision: women with a closer labor market connection when they were young are more likely to work. Simulations of demographic changes illustrate potential effects for future caregiving and participation rates.

Health insurance and use of alternative medicine in Mexico.

OBJECTIVES: I analyze the effect of coverage by health insurance on the use of alternative medicine such as folk healers and homeopaths, in particular if it complements or substitutes conventional services. METHODS: Panel data from the Mexican Health and Aging Study (MHAS) is used to estimate bivariate probit models in order to explain the use of alternative medicine while allowing the determinant of interest, access to health insurance, to be an endogenous factor. RESULTS: The findings indicate that households with insurance coverage less often use alternative medicine, and that the effect is much stronger among poor than among rich households. CONCLUSIONS: Poor households substitute away from traditional medicine towards conventional medicine.

Labor Force Participation of Mexican Elderly: the Importance of Health.

Se analizan los factores determinantes de la participación en la fuerza de trabajo de la póblacion mexicana de 50 años o más, con datos de la Encuesta nacional sobre salud y envejecimiento en México, ENASEM. Se estudió en particular la importancia de la salud en la decisión sobre la participación, tomando en cuenta la endogeneidad potencial de la salud. Los resultados indican que una mejor salud causa un mayor apego al mercado laboral. No se encontró evidencia clara de que el empleo afecte la salud, pero no puede descartarse que los efectos de las malas condiciones laborales y la justificación se eliminen mutuamente. Existen indicadores de que la autoevaluación de la salud no captura todos los aspectos relevantes de la salud. En la toma de decisiones para establecer políticas, la importancia directa de las circunstancias financieras podría ser más relevante que el papel de la salud. The determinants of the labor force participation of people in Mexico aged 50 and over are analyzed using data of the Mexican Health and Aging Study (MHAS). In particular we study the importance of health in the participation decision, taking into account the potential endogeneity of health. The results indicate that a better health causes a stronger attachment to the labor market. We find no clear evidence that employment affects health, but it cannot be ruled out that the effects of bad labor circumstances and justification eliminate each other. There are indications that self-assessed health does not capture all relevant aspects of health. For policy decisions the direct importance of financial circumstances could be more relevant than the role of health.

Transitions between care provisions demanded by Dutch elderly.

UNLABELLED: We follow people who are considered eligible for an elderly care provision. Through the estimation of a duration model we determine when they can be expected to express demand for another care provision. Data are drawn from the registrations of needs assessment agencies in The Netherlands. MAIN FINDINGS: Age positively effects the probability of a reassessment if initially care at home was assessed. Living alone, access to informal care, and applications initiated by professionals increase transition probabilities. Also initial applications for care at home due to dementia are more likely to be followed by a quick reassessment. The results can aid assessment agencies to set validity terms of assessments, and in planning future supply of services.

Eligibility for long-term care in The Netherlands: development of a decision support system.

In The Netherlands, eligibility for subsidised long-term care services is assessed by regional governmental assessment agencies. We examined which factors predict eligibility for eight long-term care alternatives, ranging from a variety of arrangements for care at home to admissions to residential and nursing homes. Data were drawn from the records of a sample of the regional assessment agencies, mostly during the year 2000. The model shows that not only disease and disability but also age, household composition, current housing situation, and use of health-care services determine the choice between the long-term care alternatives. On the basis of this model, we developed a decision support system. This system predicts eligibility for long-term care alternatives on the basis of applicant characteristics, and can support needs assessors in making decisions on the eligibility of individual applicants. It is used for standardization of intake processes and development of protocols for needs assessors. At the population level, it may provide information for managers and policy-makers on the distribution of demand for long-term care in the near future.