Health coverage for people without social security in Mexico: a retrospective cohort to assess childhood acute lymphoblastic leukaemia survival

Objectives. To measure survival of children with acute lymphoblastic leukaemia (ALL) under a public health insurance for the population without social security in Mexico, and explore patient groups that may be at risk for increased mortality. Design. Retrospective cohort study Setting. Claims data from Seguro Popular program, covering cancer treatment in people without social security, 2005-15 Participants. Children aged 0-18 with ALL across Mexico who initiated cancer treatment under this public healthcare insurance scheme. Main outcome measures. 5-year national and state-specific overall survival Results. 8,977 children with ALL were treated under Seguro Popular in 2005-15. Under this financing scheme treated children doubled from 535 in 2005 to 1,070 in 2015, and their 5-year survival was 61.8% (95%CI 60.8, 62.9). Estimates for 5-year survival remained constant over time. For 2005, 5-year survival was 60.9% (95%CI 56.7, 64.9) and for 2012, it was 61.4% (95%CI 58.2.1, 64.4). We observed wide gaps in risk-standardized 5-year survival among states ranging from 74.7% to 43.7%. We found a higher risk of mortality for children who received treatment in a non-paediatric specialty hospital (Hazards Ratio, HR=1.18; 95%CI 1.09, 1.26), facilities without a paediatric oncology/haematology specialist (HR=2.17; 95%CI 1.62, 2.90), and hospitals with low patient volume (HR=1.22; 95%CI 1.13, 1.32). Conclusions. In a decade Seguro Popular doubled access to ALL treatment for children without social security and by 2015 financed the vast majority of estimated ALL cases for that population. While some progress in ALL survival may have been achieved, nationwide 5-year survival was unsatisfactory and did not improve over time. The experience of financing childhood cancer care under Seguro Popular provides important lessons for Mexico as the health system evolves as well as for other countries moving towards universal health coverage.