Trying to make healthcare more 'efficient' by centralizing it can actually cause a massive drop in the number of people who actually go see a doctor.
March 25, 2026
Original Paper
Re-centralization and Healthcare Service Delivery: Capacity Gains, Proximity Losses, and Partisan Alignment in Mexico
SSRN · 6337878
The Takeaway
When the Mexican government took over primary care from local states to improve standards, total consultations dropped by 18%. The loss of local accountability and proximity meant that even if the 'system' was technically more professional, people felt less entitled to care and follow-up visits plummeted.
From the abstract
This study estimates the causal effect of recentralizing primary healthcare services in Mexico following the replacement of Seguro Popular with the federally managed INSABI in 2020. Exploiting subnational variation in states' decisions to return administrative authority to the federal government, we use a staggered difference-indifferences design to examine changes in healthcare utilization across public primary care facilities. We find that recentralization led to an 18 percent decline in total