Mexico's Health Insurance Success Offers Lessons for U.S.

As America considers major healthcare reforms, it may have lessons to learn from Seguro Popular, Mexico's ambitious plan to improve healthcare for its estimated 50 million uninsured citizens, suggests Ryan Moore, co-author of a study published April 8 in The Lancet, a leading international medical journal.

The study, conducted through a partnership of Mexican health officials and researchers from leading American universities, offers a model U.S. policymakers might use to scientifically explore solutions to America's own looming healthcare crisis, a proven experimental approach capable of providing objective answers to even the most controversial and politically charged questions.

"If the administration has done arms-length science and has involved third parties, like the researchers who were involved in this study, then the case that the administration can make for continuing these programs is much stronger," said Moore, an assistant professor of political science in Arts & Sciences at Washington University in St. Louis. "They're more likely to get at the truth — it's good politics and it's good science."

The article, "Public Policy for the Poor? A Randomized Assessment of the Mexican Universal Health Insurance Program," details a massive, two-year field experiment designed to evaluate Mexico's push to bring better healthcare to communities ranging from remote villages to crowded urban areas. The study turned dozens of Mexican communities into real-world laboratories where causal effects of the insurance program could be empirically measured and evaluated at the household level as new services rolled out in phases across seven Mexican states: Guerrero, Jalisco, Estado de Mexico, Morelos, Oaxaca, San Luis Potosi and Sonora.

Moore and colleagues developed the experimental design, wrote public-use software to implement it and then "tied their own hands" by publishing a preliminary study detailing exactly how the experiment and analysis would be carried out — a process designed to insulate findings from after-the-fact political meddling.

Researchers identified 74 matched pairs of communities that shared similar demographic and health conditions, and worked with Mexican officials to conduct household surveys capturing a baseline snapshot of each community's health status. Then, working independent of the Mexicans, researchers randomly selected one from each matched pair of communities for early introduction of Seguro Popular, establishing a controlled framework in which individual changes in health experiences in one community could be empirically compared to control conditions in the matching community.

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