Association between changes in out-ofpocket expenditures during 2020 with the Covid-19 pandemic in Mexico.

OBJECTIVE

To disentangle the contribution of the Covid-19 pandemic and the abolition of the Seguro Popular (SP) health protection system to changes in out-of-pocket health expenditures (OPE) in Mexico during 2020.

MATERIALS AND

METHODS

We used national representative surveys between 2014 and 2020. We described OPE in absolute and relative terms and per disposable income. Changes in OPE were estimated using adjusted two-part models. Results were reported nationally, by health insurance and income quintile.

RESULTS

OPE increased for all in 2020 with the largest increases for the high- and very high-income households and those with social security (30.4, 23.4 and 22.2 USD, respectively). Households with no health insurance and those with Seguro Popular/Instituto de Salud para el Bienestar had the lowest increase in OPE. However, for the lowest income households and those with no social security, OPE represented the highest proportion per disposable income as their income decreased during the Covid-19.

CONCLUSIONS

Social safety nets, including access to health care services for the uninsured and lower income households, are crucial.