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Inequitable Financial Protection in Health for Indigenous Populations: the Mexican Case

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Abstract

Background

There is an important gap in the literature concerning the level, inequality, and evolution of financial protection for indigenous (IH) and non-indigenous (NIH) households in low- and middle-income countries. This paper offers an assessment of the level, socioeconomic inequality and middle-term trends of catastrophic (CHE), impoverishing (IHE), and excessive (EHE) health expenditures in Mexican IHs and NIHs during the period 2008–2020.

Methods

We conducted a pooled cross-sectional analysis using the last seven waves of the National Household Income and Expenditure Survey (n = 315,829 households). We assessed socioeconomic inequality in CHE, IHE, and EHE by estimating their Wagstaff concentration indices according to indigenous status. We adjusted the CHE, IHE, and EHE by estimating a maximum-likelihood two-stage probit model with robust standard errors.

Results

We observed that, during the period analyzed, CHE, IHE, and EHE were concentrated in the poorest IHs. CHE decreased from 5.4% vs. 4.7% in 2008 to 3.4% vs. 2.9% in 2014 in IHs and NIHs, respectively, and converged at 2008 levels towards 2020. IHE remained unchanged from 2008 to 2014 (1.6% for IHs vs. 1.0% for NIHs) and increased by 40% in IHs and NIHs during 2016–2020. EHE plunged in 2014 (4.6% in IHs vs. 3.8% in NIHs), then rose, and remained unchanged during 2016–2020 (6.7% in IHs and 5.6% in NIHs).

Conclusion

In pursuit of universal health coverage, health authorities should formulate and implement effective financial protection mechanisms to address structural inequalities, especially forms of discrimination including racialization, that vulnerable social groups such as indigenous peoples have systematically faced. Doing so would contribute to closing the persistent ethnic gaps in health.

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Data Availability

The dataset used and/or analyzed during the current study are available from the first author on request.

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Acknowledgements

We acknowledge the valuable assistance of Patricia E. Solís and Michael H. Sumner in translating this manuscript into English.

Data Sharing

The data for the analysis were requested and obtained from the surveys public repository hosted at the National Institute for Statistics and Geography (available at https://www.inegi.org.mx/programas/enigh/).

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Authors and Affiliations

  1. Center for Health Systems Research, The National Institute of Public Health, Cuernavaca, Mexico

    Edson Serván-Mori, Sergio Meneses-Navarro & Octavio Gómez-Dantés

  2. The National Council of Humanities, Sciences and Technology, Del. Benito Juarez, Mexico

    Sergio Meneses-Navarro

  3. Tecnologico de Monterrey, School of Social Science and Government, Monterrey, Nuevo Leon, Mexico

    Rocio Garcia-Diaz

  4. Center for International Studies, The College of Mexico, Mexico City, Mexico

    Laura Flamand

  5. Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA

    Rafael Lozano

  6. School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico

    Rafael Lozano

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  1. Edson Serván-Mori
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Correspondence to Sergio Meneses-Navarro.

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Memorial dedication

We dedicate this manuscript to our colleague, professor, and friend, Sandra Sosa-Rubí, PhD, who passed away in March 2021; Sandra consistently inspired us in our analysis of equity and financial protection in health during her fruitful lifetime.

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Serván-Mori, E., Meneses-Navarro, S., Garcia-Diaz, R. et al. Inequitable Financial Protection in Health for Indigenous Populations: the Mexican Case. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01770-8

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