# Out-of-pocket healthcare expenditures in older Mexican people based on their social security status

## TL;DR

This study examines how social security status affects out-of-pocket healthcare costs in older Mexican adults and finds that those with stable social security coverage had the highest expenses.

## Contribution

The study reveals that stable social security coverage in Mexico is associated with higher out-of-pocket healthcare expenditures in older adults, contrasting with global trends.

## Key findings

- Individuals without social security reported the lowest mean out-of-pocket expenditures.
- Older adults with stable social security coverage showed the highest mean expenditures on total OOPE.
- Factors like education, health status, and disability had stronger associations with OOPE than social security.

## Abstract

Out-of-pocket health expenditures (OOPEs) represent a financial strain that can increase the risk of impoverishment, especially in older people. Universal health coverage is the primary strategy to ensure financial protection. The Mexican health system is based on social security. Therefore, the objective of this research is to analyze the relationship between OOPEs and social security status over time among Mexican adults aged 50 and older. A secondary analysis was made using data from the 2012, 2015, 2018, and 2021 waves of the Mexican Health and Aging Study. Multivariable linear regression models were performed to identify the relation between social security and OOPE. Individuals without social security reported the lowest mean expenditures. In contrast, older people with social security stability showed a steady increase in spending throughout the period, reporting the highest mean expenditures on total OOPE. Other variables, such as education, work, economic situation, multimorbidity, disability, and self-rated health status, show a greater relation with OOPE in contrast with social security. Our findings indicate that older adults with stable social security coverage reported the highest OOPE. This finding contrasts with international evidence on the protective role of health insurance. These findings may be attributed to four factors: (i) the challenging epidemiological profile of older adults characterized by chronic diseases and disability, (ii) the structural and organizational changes in the Mexican health system following the political transition in 2018, (iii) a decline in healthcare access among older adults during the COVID-19 (coronavirus disease) outbreak, and (iv) the longstanding oversaturation and low health resources in the health system.