Violence in Mexico and Healthcare Access: Evidence from the U.S.-Mexico Border Region

Kimberley Geissler, University of North Carolina at Chapel Hill
Charles Becker, Duke University
Sally Stearns, University of North Carolina at Chapel Hill
George Holmes, University of North Carolina at Chapel Hill

Eleven to 50% of residents in the US-Mexico border region cross into Mexico for healthcare for reasons including low-priced provider options and looser prescribing requirements in Mexico. Violent crime has risen rapidly in northern Mexico since 2007, increasing risks associated with crossing for healthcare. Using state inpatient discharge databases for California, Arizona, and Texas (2005-2010), we estimate the effect of crime on the probability a hospital discharge was for an ambulatory care sensitive condition (ACSC) using a difference-in-difference approach. A one unit increase in homicide rates in the nearest Mexican municipality for the prior three months was associated with a 0.36 percentage point increase in the probability of being discharged for an ACSC in border counties. The effect was larger for uninsured patients, who may be more reliant on the Mexican healthcare system. Expanding access in the border region may mitigate these effects by providing an alternative source of care.