Health insurance and use of alternative medicine in Mexico
Introduction
Traditionally, health insurance in Mexico is a component of the social security package available for employees with a formal job and their close relatives. For people without social security (about half of the population), relatively simple issues such as visiting a doctor or using medication often are too expensive. In 2003, the nationwide rollout of a health insurance program providing universal coverage has started, improving the access to health care. One objective for the expansion of access to health insurance is the promotion of the use of conventional therapies while discouraging the use of alternative treatments. Conventional therapies are offered by formally acknowledged and certified institutions, and generally apply scientifically proven methods, while for alternative treatment the quality is generally unproven but based on belief. Here, ‘alternative treatment’ refers to non-conventional, ‘complementary and alternative medicine (CAM)’ such as homeopaths and acupuncturists, but also to traditional therapies such as curanderos (folk healers), yerberos (cure with medicines extracted from plants) and hueseros (bone-setter, folk chiropractor).1 Health insurance usually covers only the conventional services but not alternative treatment. The latter however are often cheaper, and may be the only services within reach of people without insurance.
Social security in Mexico is provided through two large institutes, the IMSS (Instituto Mexicano del Seguro Social, Mexican Institute for Social Security) for the private sector and the ISSSTE (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Government Workers’ Social Security and Services Institute) for the public sector employees, and a number of smaller institutes (e.g. for the state oil company Pemex, the army, the navy, federal states, municipalities). Apart from health insurance, the social security package includes retirement and disability pensions, job protection, childcare services, and a housing fund. Altogether they cover just over half of the population. The other half of the population, working in the informal sector, is not covered by a social security scheme and, what is relevant for this paper, therefore has limited access to health services [2], [3]. State-owned hospitals and clinics are available for uninsured people but charge a fee, and deliver services of a lower quality, in particular with longer waiting times [4]. The currently ongoing nationwide rollout of Seguro Popular (Popular Health Insurance) will provide health insurance to informal sector workers and others not covered by social security [5]. Thus, access to insurance and health care services is growing and universal coverage is within sight, however through different insurance schemes dependent on employment status, where informal workers will not obtain the other services of the social security package.
Recent publications show that access to health insurance in Mexico increases the use of conventional health care services, more specifically of doctor visits, hospitalization, and preventive exams [6], [7]. A relevant question is if this new use of conventional services replaces other services, in particular alternative and traditional therapies, or is additional to them. In this paper I analyze if conventional services and alternative medicine can be considered as complements or substitutes. Does access to formally approved services through health insurance coverage reduce the use of alternative services?
Section snippets
Decision-making framework
An individual's demand for services provided by the social security (HS) and for alternative medicine (HA) can be described as a utility-maximization problem, U(C, HS, HA), where C indicates consumption of all other goods and services. An individual maximizes utility subject to a budget constraint that guarantees that the total expenses are not higher than the available income (Y): pSHS + pAHA + pCC ≤ Y, where pS, pA, and pC are the prices of formal health services, alternative treatment, and other
Average effect
Table 1 presents the results of the estimations of the weighted pooled bivariate probit model. If I do not account for the endogeneity of health insurance, the effect of access to health insurance on the use of alternative medicine is found to be negative but small and insignificant (column 1). Poor health in general, and stomach aches and problems with daily activities specifically, increase the use of alternative therapists, as does a (previous) period of cancer.
Column 2 shows the results of
Discussion
The increase in the use of conventional services in Mexico due to health insurance access, as is found by Wong and Díaz [6] and Pagán et al. [7], is in line with the decision-making framework outlined above: with health insurance the (absolute and relative) price for services is lower, and, given the health and socio-economic status, an increase in the demand for conventional services is likely. However that observation does not imply that it is accompanied by a reduction of the use of
Conclusions
Existing research for Mexico has shown that access to health insurance increases the use of health care services, in particular doctor visits, hospitalization, and preventive exams [6], [7]. In this paper I have analyzed the effect of coverage by health insurance in the population aged 50 years and older on the use of alternative medicine, which includes traditional treatment provided by e.g. folk healers and other non-conventional services such as homeopaths.
The findings suggest that economic
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