“Those who lost their health insurance were 2.11 times more likely than those who remained insured to stop taking medications for their chronic conditions.”
Krishnateja Kommera, Jose Eduardo Cabrero Castro, Brian Downer
Introduction and Background
Mexico has experienced a significant demographic shift, with life expectancy increasing and the population of older adults projected to reach nearly 23% by 2050. This aging trend occurs within a fragmented healthcare system where insurance is typically divided between employer-based social security, government programs for the unemployed or informal workers, and private providers. To address the needs of a large uninsured population, Mexico introduced the Seguro Popular program in 2004, which successfully expanded coverage to millions, particularly in rural and low-income areas. However, in January 2020, Seguro Popular was replaced by the Instituto de Salud para el Bienestar (INSABI). This transition led to a sharp increase in the uninsured population; the number of households without insurance nearly doubled between 2018 and 2020. This study sought to understand how becoming uninsured during this policy shift affected healthcare use for middle-aged and older Mexican adults with chronic health conditions.
Data and Methods
Researchers analyzed data from the Mexican Health and Aging Study (MHAS), a nationally representative longitudinal study of Mexican adults aged 50 and older in Mexico. They compared information from the 2018 wave (conducted under Seguro Popular) to the 2021 wave (conducted under INSABI). The final sample consisted of 6,051 participants who reported diagnosis in both waves of at least one chronic condition, including diabetes, hypertension, arthritis, asthma, heart attack, or stroke.
The study used logistic regression models to measure the association between losing health insurance and three primary outcomes: stopping medications for chronic conditions, stopping medications due to cost, and failing to see a doctor for a serious health problem. The models were adjusted for factors like age, gender, education, and community size.
Results
The study found that approximately 21% of participants who were insured in 2018 had become uninsured by 2021. More specifically, about 47% of participants with Seguro Popular in 2018 were uninsured in 2021.
- Those who lost their health insurance were 2.11 times more likely than those who remained insured to stop taking medications for their chronic conditions.
- Former Seguro Popular beneficiaries were 2.28 times more likely to discontinue medications for their chronic conditions if they became uninsured.
- Becoming uninsured was associated with 1.95 times higher odds of stopping medication due to cost and 1.50 times higher odds of not seeing a physician for a serious health issue.
- The most cited reason for skipping medical visits was a lack of money; uninsured individuals were nearly five times more likely than those with insurance to report cost as the barrier.
Public Health Implications and Future Directions
These findings suggest that the transition from Seguro Popular to INSABI created significant gaps in care for Mexico’s most vulnerable middle-aged and older adults. To mitigate these risks, the researchers suggest prioritizing continuous insurance coverage to prevent interruptions in treatment. Specific recommendations include:
- subsidizing essential medications to reduce cost barriers;
- expanding mobile health services for rural populations;
- providing geriatric-focused training for healthcare professionals to better engage older patients.
As Mexico continues to reform its system, like the replacement of INSABI with IMSS Bienestar in 2023, ongoing evaluation is critical to ensure these new programs effectively protect the health and financial well-being of older adults with chronic conditions.
Read the Original Paper
Kommera, K., Cabrero Castro, J. E., & Downer, B. (2025). The association between becoming uninsured and forgoing medical care among middle-aged and older adults in Mexico with chronic health conditions. Innovation in Aging, 9(8), igaf078. https://doi.org/10.1093/geroni/igaf078
Acknowledgements
This study was supported by the Sealy Center on Aging at the University of Texas Medical Branch and was funded by the National Institutes of Health/National Institute on Aging (R01AG068988, P30AG059301, P30AG024832). The MHAS is supported by the National Institutes of Health/National Institute on Aging (R01AG018016, R Wong, PI) and by the INEGI in Mexico.
San Antonio CAPAS acknowledges the use of AI to support the elaboration of the initial draft. See the process by which our team created the synopsis: Research Synopsis Elaboration.