viernes, 8 de mayo de 2009

Swine-nonomics II: Why Mexicans Die of Influenza? (Columna para The News, que no se publicó)

It was Chicago University professor, Gary Becker, who first brought economics into every day topics. When we get married, when we cheat on an exam at school, when we have children, whether we go to the doctor or not when we have a cold, whether we take some time off to go to the hospital when we have a high fever, we are constantly taking economic decisions at the very micro level.

Professor Becker ended up receiving the Nobel Prize on Economics, and the recent fame and reputation of American economists Stephen Dubner and Steven Levitt (the guys from Freakonomics) is directly tributary to Becker’s work and research.

Yes, why Mexicans have died while influenza patients elsewhere have only experienced moderate nuisances can be explained (at least partially) by economics.

Of course that richer countries such as Canada and the US enjoy better and more sophisticated health systems and hospital networks, but that is not the main reason why Mexicans died during the current outbreak. If there is not a clinical-biological reason (i.e. the virus are different) why patients died this side of the Rio Grande but not on the other side, then the reason is economics.

The most brought up answer for this particular question is: Mexican patients who died influenza took too long in checking into the hospital. The reason for this is strictly economics: going to the doctor is much more expensive in Mexico than it is elsewhere in North America, and that is precisely the reason why Mexicans medicate themselves.

I can think of at least the following reasons why going to the doctor is very expensive in Mexico:

a) Mexicans are poorer overall, and this means that an hour off their jobs to go to the doctor represents a higher portion of their monthly income than it does for Americans or Canadians,
b) Mexico’s economy suffers from a disproportionally large “informal” economy run mostly by liquid cash. This means that an hour off their street shops to see the doctor reflects immediately in a loss of income. In a formal economy, with jobs markets regulated by contracts and electronic transfer payments it is easier to take time off to see the doctor without losing monetary revenues. That is also the reason why the Mexico City government was able to shut down restaurants but not move street vendors off their locations, with the consequences on the effectiveness of the precautionary health measures,
c) So taking an hour off to see the doctor is more expensive than it is in the US. Now take this into consideration: for the average Mexican, being consulted by a doctor at the IMSS-ISSSTE public health network may take precious critical hours. Just read the sad accounts at this week’s Proceso magazine of the patients who died because they were admitted to hospitals days after they first sought to check in. We may hire a consultant in order to measure how long Mexico’s public health system takes to check a patient for the first time, but Mexicans can tell you better: it just takes too long, so long that the revenue (monetary or other) lost in going to the doctor is just too high and is easier to self medicate or procrastinate on your doctor check up,
d) Mexico’s public health system is in shambles overall, and the discomfort suffered every time a Mexican goes to the doctor is also a cost that enters into the equation every time a Mexican with a cold and high fever decides to self medicate or wait until she feels better,
e) In a humungous metropoly such as Mexico City, going to a hospital, even a private hospital, may be extremely time consuming.(now that we know the elevated cost of influenza, this will be less of a factor in the future)

As a result, Mexicans are not used going to the doctor when they feel sick. It really caught my attention when I lived and worked in the US as an economic consultant that Americans drive to the doctor whenever they sneezed (and the saying goes, when the US sneezes, Mexico catches pneumonia, never as literal!).

Why if, as all data suggests, the influenza virus struck Mexico and the US almost at the same time so it caught populations off guard on an equal basis, patients died this side of the Rio Bravo, but not in the US? My economic sixth sense tells me that it was a matter of the the high cost of going to the doctor in Mexico. More on Swine-nonomics III.

2 comentarios:

Manuel A. Bautista González dijo...
Este comentario ha sido eliminado por el autor.
Manuel A. Bautista González dijo...

It was a great analysis! I that the segmentation of Mexican people in (at least) three categories was also a cause to consider. Sick people in the country either lack social security, can go to the social security system but have a negative (monetary) incentive to go to the doctor (in the terms you describe), or demand private health services if they can afford them.
Thus this was a "stable" equilibrium solution in pre-influenza Mexico. However, a "flu" shock showed how fragile the health system turned out to be.