Elsevier

Health Policy

Volume 75, Issue 2, January 2006, Pages 170-177
Health Policy

Self-medication and health insurance coverage in Mexico

https://doi.org/10.1016/j.healthpol.2005.03.007Get rights and content

Abstract

Self-medication is a common practice in many developing countries but little is known about its determinants. This study analyzes the factors that are associated with the use of self-medication in Mexico using the Mexican Health and Aging Study, a new nationally representative survey on adults aged 50 and over. We find that self-medication is related to socioeconomic status and the lack of access to professional healthcare. Our empirical results suggest that lack of government-sponsored health insurance coverage increases the propensity to self-medicate. A 10% increase in the proportion of adults with health insurance coverage could decrease the use of pharmacy consultations by .8% for public sector workers and by 1.7% for private sector workers. Increasing health insurance coverage could reduce the demand for self-medication by making healthcare more affordable and by changing the population perceptions about the benefits of modern medicine.

Introduction

In many developing countries, self-medication is a common practice due to quality concerns related to healthcare delivery systems as well as skepticism about the benefits of professional healthcare vis-à-vis traditional medicine [1]. In Mexico, self-medication has grown in recent years due to the increasing availability of over-the-counter (OTC) drugs, especially those which were previously available only by prescription. During the late 1990s, the Mexican Ministry of Health switched more than 200 prescription drugs to OTC status. As a result, the Mexican market now has more than 500 different OTC products [2].

Mexico spends about 5.7% of its GDP on health compared to, for example, 13.7% by the US and 8.6% for Canada [3]. As such, the Mexican healthcare system faces many challenges when it comes to adequately addressing the health care needs of a rapidly growing and aging population. Many individuals delay formal medical care, underutilize preventive care, rely on alternative medicine and/or use self-medication to improve their health [1]. Consequently, it is not surprising that out-of-pocket medical expenditures represent the largest share of total healthcare spending in Mexico [4].

Using survey data on adults aged 50 and over from the Mexican Health and Aging Study (MHAS), this study analyzes the factors that are associated with the use of self-medication in Mexico. Following extant research, we define self-medication as having any pharmacy visits/consultations about health problems without any previous contact with other health care providers. This working definition includes OTC drugs purchased without prescription [5]. Thus, self-medication can be viewed as an alternative to utilizing the formal healthcare system. We are particularly interested in the relationship between socioeconomic status, the availability of health insurance and self-medication. Evaluating how these factors are related to self-medication could inform policymakers about how healthcare reform via increases in health insurance coverage for different groups could influence self-medication patterns.

Section snippets

Background: why self-medication matters

More than 30 million Mexicans self-medicate at least once a year and the medical community recently began to express concerns about the potential health risks of this practice [6], [7]. There are several reasons for the widespread use of self-medication in Mexico. First, professional medical care is relatively unaffordable to large segments of the population. More than half of those with serious illnesses do not use medical services because they find them to be too expensive or they do not have

Conceptual framework

The conceptual framework utilized here is based on the self-medication utility maximizing model of Chang and Trivedi [5]. This model contrasts the choice to improve individual health through professional medical care (e.g., visiting a physician or hospital/clinic) or self-medication (e.g., purchasing medication at a pharmacy or consulting a pharmacist). Although generally priced lower than professional medical care, self-medication could be associated with health-related risks (e.g., side

Data and methodology

We used data from the first wave of the Mexican Health and Aging Study (n = 15,156), a nationally representative prospective panel study covering both urban and rural areas in all 31 states of Mexico and the Federal District. The sampling framework of MHAS was based on the household listings from the fourth quarter of the 2000 Encuesta Nacional de Empleo (ENE, National Employment Survey). The survey was funded by the US National Institute on Aging and fielded by the Instituto Nacional de

Empirical results

Table 1 reports the descriptive statistics of the variables used in the logistic regressions, by whether or not respondents consulted a pharmacist within the last year, or whether or not they would consider consulting a pharmacist for a minor health problem in the future. All the means, proportions and estimated models are weighted to appropriately reflect the sampling design of MHAS. The P-values of the differences in means/categories are reported in columns 6 and 11 of Table 1. After applying

Conclusion

According to MHAS data, roughly one of every eight Mexican adults aged 50 and over has consulted a pharmacist within a year prior to the interview date. There are substantial health-related differences between actual and hypothetical users of self-medication, with larger differences in health status for actual rather than potential users. Mexicans resorting to self-medication have relatively fewer years of education, lower income and fewer accumulated assets. They are also more likely to reside

Acknowledgments

Support for this study was provided by the Population Aging Research Center (PARC) of the University of Pennsylvania (National Institutes of Health/National Institute on Aging, Grant No. P30 AG12836). We also thank the support of the Robert Wood Johnson Health and Society Scholars Program. NIH/NIA Grant No. R01 AG18016, The Mexican Health and Aging Study, Beth J. Soldo, P.I. supported the collection of the data analyzed in this paper.

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