Survey on Medical Insurance for a New Generation (ESMNG) 2009

On May 15th, 2003 the decree that amends and adds the General Health Law was published in the Official Journal of the Federation, by which the Social Protection System in Health was created as a mechanism for financial protection in which the state guarantees the effective, timely and quality access, without payment at the time of use and without discrimination to medical-surgical, pharmaceutical and hospital services that meet comprehensively the health needs of the population without social security.

Since 2006 the Federal Government through the Ministry of Health launched the Medical Insurance for a New Generation (SMNG), whose overall objective is:

• To promote, address and maintain a better state of health for Mexican children under 5 years born after December 1st, 2006, not being affiliated to a social security system through the free provision of high quality health care in prevention, diagnosis, treatment and rehabilitation.

Since its approval as a federal program, it was recognized the need to evaluate through a continuous and systematic process, which together with the operational monitoring will implement, where appropriate, adjustments to the design and execution, as well as complementary actions in the system. The evaluation aims to determine the performance and impact of SMNG into three components:

• Evaluation of the program design.
• Evaluation of the performance.
• Evaluation of the impact on health and family economy.

To address this need, the National Commission for Social Protection in Health agreed with the Children's Hospital of Mexico “Federico Gomez” (HIMFG), to perform the evaluation of the federal program called SMNG, since that institution has as an objective, among others, the study and investigations on sociomedical research areas in the field of their specialties, as well as to promote health measures.

The HIMFG requested the National Institute of Statistics and Geography (INEGI) their collaboration to design and conduct the first Survey on Medical Insurance for a New Generation 2009, for which a cooperation agreement was signed on November 21st, 2008.

For the survey design an interdisciplinary team was formed with personnel from the INEGI and the Center for Economic and Social Studies Health of the Children's Hospital of Mexico “Federico Gomez”, which dedicated itself to review, among other issues, the National Survey on Health and Nutrition 2006 and the National Survey of Household Income and Expenditure; the operating rules for the SMNG and various UN documents for the development of the conceptual framework. Documents on methodologies of the Multiple Indicator Cluster Surveys (MICS) were also reviewed.

Target population
Children born since December 1st, 2006 registered at Medical Insurance for a New Generation (SMNG) until September 30th, 2008.

Thematic coverage

• Characteristics of the housing unit and identification of households.
• Sociodemographic characteristics.
• Reproductive and maternal child health.
• Delivery characteristics.
• Breastfeeding and feeding.
• Affiliation.
• Use and satisfaction of health services.
• Use of preventive health services and vaccination.
• Diseases and accidents.
• Attending workshops or talks for self-care.
• Health expenses.
• Total household expenses and income.
• Mortality.

Classifiers used

• Mexican Classification of Occupations (CMO), 1996.
• Mexican Classification of Economic Activities (CAE), 1994.
• International Classification of Diseases, Tenth Revision, WHO.
• Catalog of Municipalities and Localities.

International recommendations
The operating rules of the Medical Insurance for a New Generation, the General Health Law, and others are followed; as well as the National Survey of Health and Nutrition (ENSANUT 2006) and documents endorsed by the United Nations (UN).

Sample size
12,240 children affiliated to Medical Insurance for a New Generation.

Observation unit
The household.

Sampling unit
The housing unit.

Analysis unit
Girls and boys affiliated of the SMNG, born between December 1st, 2006 and September 30th, 2008.

Sampling framework
Database of children affiliated to SMNG, whose source is the directory of Seguro Popular developed and updated by the Ministry of Health, at a state and domain level.

Sampling scheme
Probabilistic, three-stage and by clusters.