Long-term effects of universal health insurance in developing countries: Evidence from Mexico

Project Title Long-term effects of universal health insurance in developing countries: Evidence from Mexico Project Summary/Abstract (30 lines of text) The implementation of government programs to increase access to health insurance has rapidly increased in developing countries in the last three decades. However, evidence on their long-term effects in a developing

country is limited and provides mixed conclusions. Understanding the persistent impact of universal health insurance is particularly relevant as the hypothetical health improvements and reduced financial burden they may offer have the potential to shrink intergenerational transmission of poverty and improve social mobility of

beneficiaries and their children. The efficacy of these programs remains unclear predominantly because of a lack of random variation in their implementation and the fact that in randomized controlled trials, control groups typically receive the benefits, at most, only a few years after the initial implementation. Long-term

evaluation of these programs is further complicated by the substantial challenges of consistently tracking and following up baseline respondents, which can lead to bias-inducing, non-random attrition. This project contributes to filling the gap in what is understood about the broad consequences of increased access to

health insurance in developing countries. Specifically, we provide new evidence from a population- representative sample on the long-term effects of Seguro Popular, a universal public health insurance program introduced in Mexico in 2002. Pairing the richness and innovative design of the Mexican Family Life

Survey (MxFLS), a nationally representative, longitudinal survey with cutting-edge and rigorous non- experimental methods, represents a unique opportunity to make a substantial contribution to understanding the persistent impact of programs that increase access to health insurance in developing countries. The

MxFLS collects comprehensive respondent data across time whereby every respondent surveyed in Mexico at baseline in 2002, and any of their children born after 2002, are target respondents for follow-up survey waves, including those who are domestic or international migrants. By integrating the MxFLS's ability to track

economic and health outcomes of respondents over multiple years with the temporal and spatial variation created by Seguro Popular's rollout, as well as, the biological variation generated by the age individuals are first exposed to the program, this project will: 1) identify the causal effects of Seguro Popular on child height,

which has been causally associated with indicators of well-being in later life, e.g., educational attainment, earnings, adult health, and mortality; 2) explore the dynamic impact across time of this health insurance policy to provide new insights into how supply and demand side constraints at the time of program

implementation can alter its effectiveness; and 3) provide evidence on the impact of Seguro Popular on household expenditure, labor market, investment, risk, and migration behavior. In so doing, the project will have provided scientific evidence on the extent to which the provision of health insurance in a developing

country setting improves the lifelong health and wellbeing of its population.