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New insights into “catastrophic” expenditure in Latin America and the Caribbean


As of 2012, Mexico is well on the road to universal health coverage. In less than a decade, thanks to Seguro Popular, a national health insurance program introduced in 2003, every Mexican is now covered by a public insurance scheme. The program offers health services and financial protection to over 50 million Mexicans who were previously uninsured.

For nearly a decade, a program of research fed into the design, implementation, and monitoring of Seguro Popular. According to research leader Felicia Knaul, documenting the extent to which small, health-related expenses were deepening poverty provided the evidence political leaders needed to commit to reforms.

“The research changed our conception of what is catastrophic,” says Dr Knaul. “For someone at the poverty line on minimum wage, having two kids with throat infections, losing a few days of work, paying to see a doctor and then for antibiotics…this kind of thing adds up quickly — in some cases to 30% or more of household income.”

To sustain and extend such policy-relevant analysis on health equity and financing, IDRC supported a seven-country project led by Fundación Mexicana para la Salud from 2007 to 2011. The project grew into LANET-EHS (Latin American Research Network on Equity and Health Systems), a 12-country regional network. Through the network, country-based teams have collaborated and learned from each other, sharing evidence and methodologies and carrying out comparative cross-country research. Colombia and the Dominican Republic are just two countries in which current debates on health coverage are being shaped in part by evidence from LANET-EHS.

The network has disseminated its findings on household health spending and the fairness of health financing in policy briefs, research papers published in The Lancet and Salud Pública de México, and a forthcoming volume to be published by Harvard University Press.

“The research changed our conception of what is catastrophic.”

Felicia Knaul, Director of the Harvard Global Equity Initiative and Senior Economist at the Mexican Health Foundation, is a co-leader of the IDRC-supported Global Network for Health Equity.

Felicia Knaul