Who Benefits from Free Health Insurance?

ABSTRACT We present a comprehensive evaluation of the health impacts of the introduction and expansion of a large noncontributory health insurance program in Mexico, the Seguro Popular (SP), which provided access to health services without co-pays to individuals with no Social Security protection. We identify the program impacts using its rollout across municipalities between 2002 and 2010. In general, we do not detect significant effects on mortality (overall or at any age); the only exception is a reduction in infant mortality in poor municipalities for which intention- to-treat estimates show a 10 percent decline due to SP. This decline is attributable to reductions in deaths associated with conditions originating in the perinatal period, congenital malformations, diarrhea, and respiratory infections. In these poor municipalities, SP increased obstetric-related hospital admissions by 7 percent and hospital admissions among infants by 6 percent. There were no impacts on mortality or use of hospitals in rich municipalities. The decline in infant mortality rate caused by SP closed nearly all of the infant mortality rate gap between poor and rich municipalities.