1. Willingness to Pay For Cross-Border Health Insurance between the United States And Mexico Arturo Vargas Bustamante Assistant Professor of Health Services UCLA School of Public Health avb@ucla.edu

2. Co-Authors Gilbert Ojeda, Director of the Program on Access To Care, UC-Berkeley School of Public Health, UC-Berkeley, Xóchitl Castañeda, Director of the Health Initiative of the Americas, UC-Berkeley School of Public Health, UC-Berkeley,

3. Presenter Disclosures Arturo Vargas Bustamante “No relationships to disclose”

4. Outline Background Study Objectives Willingness to Pay Results

5. Background  Approximately 12 million people of Mexican-origin live in the U.S.  61.7% longer stayed (<10 years) and 43.7% recent arrivals have health insurance coverage  Three times less likely than native-born U.S. citizens to have insurance  Mexicans represent 68% of the total number of undocumented U.S. workers

6. Background  Previous research shows that Mexicans living in the U.S. usually go back to Mexico to receive some health care  They also sent $23 billion last year as remittances. Almost half of recipient families (46%) used a share for health expenditures  More economic and social interaction since NAFTA  Costs are 50% to 90% lower in Mexico

7. Study objectives  Estimate the WTP for a new cross-border plan and assess its main determinants  The hypothetical plan, agreed by a binational panel of experts: ambulatory and preventive care in U.S., more costly treatments in Mexico (dependents and transportation costs covered)  Copa Federaciones: A soccer tournament where players of 12 different states played each other. Low-cost opportunity to access a broad sample

8. Willingness to Pay  Referendum format (yes/no) to minimize tendency to exaggerate. It reflects real-world behavior  Professional valuators of a for-profit health plan in California estimated the cost of the product in $150- $250 a month, covering the subscriber and two to five dependents in Mexico  Main assumption: Subscribers will pay half  3 questions: a) $75-$125 a month b) Services in Mexico public providers c) $150-$250 for Mexican private

9. Results  Survey was well accepted: 90% response rate  N= 702 observations, 91% born in Mexico  Slightly over-represents longer stayed immigrants (66% of the sample >10 years in the U.S.)  Replicate present trends: Those with insurance more likely to use services, 46% sent remittances for health, slightly more male, 44% undocumented  First source of information on dependents: 44% had relatives in Mexico with insurance

10. Results

11.  WTP: 62%, WTP-Public: 57%, WTP-Private: 23%  Logit model - Determinants of WTP: a) Having dependents in Mexico WITH insurance b) Sending remittances for health purposes  Policy implications for cross-border insurance: a) Under guest-worker program b) Conditional amnesty  Main needs: Guarantee quality services, homogenize regulations across states in the U.S.

12. Willingness to Pay For Cross-Border Health Insurance Between the United States And Mexico Arturo Vargas Bustamante Assistant Professor of Health Services UCLA School of Public Health avb@ucla.edu