The association between becoming uninsured and forgoing medical care among middle-aged and older adults in Mexico with chronic health conditions

Background and Objectives In 2004, Mexico introduced a public health insurance program, Seguro Popular, to address the large uninsured population. The program was replaced with the Instituto de Salud para el Bienestar (INSABI) in 2020. This change led to an increase in the uninsured population. Using data from the 2018 and 2021 waves of the Mexican Health and Aging Study, we examined the association between insurance loss, medication use for chronic conditions, and health care utilization. Research Design and Methods The final sample included 6,051 participants with hypertension, diabetes, heart disease, stroke, asthma, or arthritis. We examined the following outcomes: (a) stopping medications for one or more chronic conditions; (b) stopping medication due to cost; (c) not seeing a physician for a serious health problem; and (d) the reasons for not seeking care. The main independent variable was the change in self-reported health insurance status between 2018 and 2021. Logistic regression models were used to estimate the association between losing health insurance, medication use, and not seeking medical care. Results Approximately 20% of participants who had health insurance in 2018 were uninsured in 2021. Among those taking medications for at least one chronic condition in 2018 (n = 5,518), losing insurance was associated with higher odds of discontinuing medications in 2021 (OR = 2.11). Among all participants, becoming uninsured was associated with significantly higher odds of stopping medications due to cost (OR = 1.95) and not seeing a physician for a serious health condition (OR = 1.50), with cost being the most common reason for not seeking care (OR = 4.97). Discussion and Implications Our findings suggest that the increase in the uninsured population has negatively affected health care utilization among middle-aged and older adults in Mexico.