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Introduction
Hypertension affects more than 9 million adults in Mexico and is expected to increase with rising rates of obesity. 1 Hypertension greatly increases the risk of cardiovascular diseases such as ischaemic heart disease (the second leading cause of death in Mexico) and stroke (the third leading cause of death in Mexico). 2 3 4 This year Mexico expects to spend $3bn (£1.5bn; â,¬2bn) on treating hypertension alone. 5 Studies have shown that reductions in blood pressure significantly reduce the incidence of and mortality from cardiovascular disease. 6 7 8 Despite the availability of effective drugs, treatment is suboptimal and varies by region in Mexico. 9 10
Lack of health insurance has been consistently identified as a key obstacle to antihypertensive treatment 11 12 13 14 15 and to the use of healthcare services more generally. 16 Mexico's recently implemented Seguro Popular programme, which by 2010 will legally extend health insurance to all uninsured people (about 50 million people), has the potential to increase access to treatment for hypertension, and potentially improve health outcomes. The insurance package covers 249 interventions, including diagnosis and treatment of hypertension. 17 These services are universally accessible to people insured through the programme. The law, however, stipulates that priority for affiliation is to be given to poor households in areas characterised by high deprivation, as well as to people living in rural areas and indigenous groups. 18 Affiliation with Seguro Popular is also encouraged among those families identified as having higher expected healthcare costs. Therefore the bulk of current enrollees belong to the bottom three tenths for income. 19 In addition, Seguro Popular was designed to start in communities where health facilities were sufficiently equipped to provide the services included in the insurance package. 18 In low income and rural areas, supply related factors may impede the effectiveness of the programme in increasing access to antihypertensive treatment.
Recent research exploring the impact of Seguro Popular indicates that it is having a positive effect. Inequalities in public health expenditure and treatment coverage across states have narrowed, the use of healthcare services has increased for insured compared with uninsured people, catastrophic expenditure has decreased for insured compared with uninsured people, and federal expenditure on health has increased. 19
We assessed whether Seguro...