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Chivardi C, Zamudio Sosa A. Factors influencing the technical efficiency of diabetes care at primary care level in Mexico. Health Policy Plan 2024; 39:318-326. [PMID: 38153766 DOI: 10.1093/heapol/czad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/17/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023] Open
Abstract
Diabetes prevalence is rising globally, especially in low- and middle-income countries like Mexico, posing challenges for healthcare systems that require efficient primary care to manage the disease. However, healthcare efficiency is influenced by factors beyond decision-makers, including socioeconomic and political conditions. This study aims to evaluate the technical efficiency of primary healthcare for diabetes patients in Mexico over a 12-year period and explore the impact of contextual variables on efficiency. A longitudinal analysis was conducted using administrative and socio-demographic data from 242 health jurisdictions between 2009 and 2020. Data envelopment analysis with bootstrapping and output orientation was used to measure the technical efficiency; health resources in infrastructure and human resources were used as inputs. As outcome, the number of patients receiving treatment for diabetes and the number of patients with controlled diabetes were considered. Machine learning algorithms were employed to analyse multiple factors affecting the provision of diabetes health services and assess heterogeneity and trends in efficiency across different health jurisdictions. The average technical efficiency in primary healthcare for diabetes patients was 0.44 (CI: 0.41-0.46) in 2009, reaching a peak of 0.71 (CI: 0.69-0.72) in 2016, and moderately declining to 0.60 (CI: 0.57-0.62) in 2020; these differences were statistically significant. The random forest analysis identified the marginalization index, primary healthcare coverage, proportion of indigenous population and demand for health services as the most influential variables in predicting efficiency levels. This research underscores the crucial need for the formulation of targeted public policies aimed at extending the scope of primary healthcare services, with a particular focus on addressing the unique challenges faced by marginalized and indigenous populations. According to our results, it is necessary that medical care management adjust to the specific demands and needs of these populations to guarantee equitable care in Mexico.
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Affiliation(s)
- Carlos Chivardi
- Centre for Health Economics (CHE), University of York, York YO10 5DD, United Kingdom
| | - Alejandro Zamudio Sosa
- School of Psychology, National Autonomous University of Mexico (UNAM), Mexico City 04510, Mexico
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Lin L, Zai X. Assessing the impact of public insurance on healthcare utilization and mortality: A nationwide study in China. SSM Popul Health 2024; 25:101615. [PMID: 38322784 PMCID: PMC10844660 DOI: 10.1016/j.ssmph.2024.101615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/29/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024] Open
Abstract
We investigate the effects of a significant health insurance expansion in rural China known as the New Cooperative Medical Scheme (NCMS). Our analysis is based on a nationwide dataset spanning from 2004 to 2011. We find that the NCMS effectively increases healthcare utilization, particularly inpatient admissions, and reduces the incidence for infectious diseases. In addition to the increased healthcare utilization, the reduction in the incidence for infectious diseases can be attributed to improved health knowledge and health behavior, both of which are associated with the expansion of insurance coverage. Our findings affirm the importance of insurance coverage in safeguarding low-income individuals from the adverse health consequences linked to infectious diseases.
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Affiliation(s)
- Lin Lin
- School of Public Management, East China Normal University, Shanghai, China
| | - Xianhua Zai
- Department of Labor Demography, Max Planck Institute for Demographic Research, Rostock, Germany
- Max Planck – University of Helsinki Center for Social Inequalities in Population Health, Rostock, Germany and Helsinki, Finland
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van Gameren E, Enciso N. The Impact of Seguro Popular on the Progression of Disabilities Among Older Adults With Chronic Degenerative Diseases in Mexico. Res Aging 2023; 45:599-608. [PMID: 36515312 PMCID: PMC10597644 DOI: 10.1177/01640275221146283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In a context of population aging, poverty, and inequalities including in the access to healthcare services, in 2004 Mexico initiated Seguro Popular (SP), a non-contributory health insurance providing coverage for informal sector workers excluded from social security. We analyze the impact of SP on the progression of functional limitations among adults aged over 50 with chronic degenerative diseases previously without stable health insurance. Panel data from the Mexican Health and Aging Study (MHAS) permit a difference-in-difference propensity score matching approach, comparing respondents before (2003) and after (2015) the implementation of SP. Findings suggest that SP affiliation in (or shortly before) 2012 has (weakly) slowed the progression of mobility, IADL, and ADL limitations, with a clearer effect in large urban centers. Reforms in the healthcare sector should address underlying structural barriers, reduce existing inequities, and provide effective access to high-quality services. with increased attention for long-term care needs, to guarantee healthy aging.
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Affiliation(s)
- Edwin van Gameren
- El Colegio de México, Centro de Estudios Económicos. Carretera Picacho Ajusco 20, Col. Ampliación Fuentes del Pedregal, C.P. 14110 Tlalpan, CDMX, Mexico
| | - Níobe Enciso
- El Colegio de México, Centro de Estudios Económicos. Carretera Picacho Ajusco 20, Col. Ampliación Fuentes del Pedregal, C.P. 14110 Tlalpan, CDMX, Mexico
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Zhang Z, Zhao M, Zhang Y, Feng Y. How does urbanization affect public health? New evidence from 175 countries worldwide. Front Public Health 2023; 10:1096964. [PMID: 36684862 PMCID: PMC9852986 DOI: 10.3389/fpubh.2022.1096964] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 12/15/2022] [Indexed: 01/07/2023] Open
Abstract
Urbanization is an essential indicator of contemporary society and a necessary historic stage in the industrialization of all countries. Thus, we explore the impact of urbanization on public health using the OLS estimation and a two-way fixed effect model based on annual panel data from 175 countries from 2000 to 2018. This paper also addresses potential endogeneity issues and identifies causal relationships using the coefficient stability tests, system GMM, and instrumental variable method. The results demonstrate that urbanization positively affects public health. Furthermore, we find that the impact of urbanization on public health can be mediated through living standards, and nations with higher living standards reduce the effect of urbanization on public health. An increase in the urbanization rate can promote public health by improving residents' living standards. Our results have significant real-world implications for the research of urbanization and the formulation of public health policy.
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Affiliation(s)
- Zhenhua Zhang
- Institute of Green Finance, Lanzhou University, Lanzhou, China
| | - Mingcheng Zhao
- School of Management, Lanzhou University, Lanzhou, China
| | - Yunpeng Zhang
- School of Management, Lanzhou University, Lanzhou, China
| | - Yanchao Feng
- Business School, Zhengzhou University, Zhengzhou, China,*Correspondence: Yanchao Feng ✉
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Garcia-Diaz R. Effective access to health care in Mexico. BMC Health Serv Res 2022; 22:1027. [PMID: 35962375 PMCID: PMC9373534 DOI: 10.1186/s12913-022-08417-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/31/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This paper assesses the impact of effective access on out-of-pocket health payments and catastrophic health expenditure. Effective access cannot be attained unless both health services and financial risk protection are accessible, affordable, and acceptable. Therefore, it represents a key determinant in the transition from fragmented health systems to universal coverage that many low- and middle-income countries face. METHODS We use a definition of effective access as the utilization of health insurance when available. We conducted a cross-sectional analysis using the 2018 Mexican National Health Survey (ENSANUT) at the household level. The analysis is performed in two stages. The first stage is a multinomial analysis that captures the factor associated with choosing effective access against the alternative of paying privately. The second stage consists of an impact analysis regarding the decision of not choosing effective access in terms of out-of-pocket (OOP) health payments and catastrophic health expenditures (CHE). The analysis corrects for both the decision to buy insurance and the decision to pay for health care. RESULTS We found that, on average, not choosing effective access increases OOP health payments by around 2300 pesos annually. Medicine payments are the most common factor in this increase. Nevertheless, outpatient and medicines health care are the main drivers of the increase in OOP health payments in all insurance beneficiaries. Not having effective access increases the probability of CHE health expenditures by 2.7 p.p. for the case of Social Security Insurance and 4.0 p.p. for Social Government insurance. Household enrolled in Prospera program for the poor are more likely to choose effective access while having household heads with more education and assets value does the opposite. Diabetes illnesses are associated with a higher probability of effective access. CONCLUSION Improving effective access is a middle step that cannot be disregarded when seeking universal coverage because OOP health payments and catastrophic outcomes are direct consequences. Public insurance in general, has around 50% effective access which remains a challenge in terms of health services utilization and health public policy design, calling for the need of better coordination across insurance types and pooling mechanisms to increase sustainability of needed health services.
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Affiliation(s)
- Rocio Garcia-Diaz
- Tecnologico de Monterrey, Ave. Eugenio Garza Sada 2501, Monterrey, N.L., Mexico.
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Khodakarami R, Abdi Z, Ahmadnezhad E, Sheidaei A, Asadi-Lari M. Prevalence, awareness, treatment and control of diabetes among Iranian population: results of four national cross-sectional STEPwise approach to surveillance surveys. BMC Public Health 2022; 22:1216. [PMID: 35717151 PMCID: PMC9206740 DOI: 10.1186/s12889-022-13627-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background Diabetes as a leading cause of death imposes a heavy burden on health systems worldwide. This study investigated the trends in prevalence, awareness, treatment and control of diabetes among Iranian population aged 25 to 65 years over 12 years (2004-2016). Methods Secondary data analysis was performed using data from a national population-based survey, STEPwise approach to surveillance (STEPS) for non-communicable diseases (NCDs) in four rounds (2004, 2007, 2011, 2016). The sample sizes were 89,404, 29,991, 12,103 and 30,541 individuals, respectively across the country in both rural and urban areas. Data were analyzed using descriptive statistics and a logistic regression model with odds ratio at a significance level of less than 5% with no adjustment for age and sex. Logistic regression was used to identify socio-demographic factors associated with the levels of awareness, treatment and control of diabetes mellitus. Results The prevalence of diabetes in four rounds was 8.4, 9, 11.1 and 13.2%, respectively. Among people with diabetes, 53.5, 65.6, 70.5 and 82.2% were aware of their condition and 35.9, 42, 46 and 39.6% were treated for this condition, respectively. In four rounds of study, 14.5, 20.8, 20.4 and 18.5% of all diabetic patients had adequate glycemic control, respectively. In the multivariable logistic regression analysis, there was a significant relationship between female gender, age over 40, living in the urban area, being in the third wealth quintile and having health insurance with diabetes prevalence. Female participants were more likely to be aware of the disease. Older participants were more likely to receive treatment and had adequate glycemic control. Conclusion The prevalence of diabetes in Iran has been increasing and despite the great awareness of the disease, receiving treatment and effective control of the disease are suboptimal. While several national policies to improve diabetes screening and care have been passed in recent years, it seems large gaps remain in disease detection and treatment. It is suggested that more attention be paid to the treatment and control of diabetes by NCDs national policies to prevent the growing burden associated with the disease.
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Affiliation(s)
- Rahmkhoda Khodakarami
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Zhaleh Abdi
- National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran (TUMS), No 70, Bozorgmehr St. Vesale Shirazi St., Tehran, Iran.
| | - Elham Ahmadnezhad
- National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran (TUMS), No 70, Bozorgmehr St. Vesale Shirazi St., Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Asadi-Lari
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences (IUMS), Tehran, Iran.,Oncopathology Research Centre, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Colchero MA, Gómez R, Bautista-Arredondo S. A systematic review of the literature on the impact of the Seguro Popular. Health Res Policy Syst 2022; 20:42. [PMID: 35436938 PMCID: PMC9014564 DOI: 10.1186/s12961-022-00839-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/09/2022] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND The Seguro Popular (SP) was launched in 2004 to increase access to healthcare and reduce catastrophic expenditures among the Mexican population. To document the evidence on its effectiveness, we conducted a systematic review of impact evaluations of the SP. METHODS We included papers using rigorous quasi-experimental designs to assess the effectiveness of the SP. We evaluated the quality of each study and presented the statistical significance of the effects by outcome category. RESULTS We identified 26 papers that met the inclusion criteria. Sixteen studies that evaluated the impact of SP on financial protection found consistent and statistically significant positive effects in 55% of the 65 outcomes analyzed. Nine studies evaluating utilization of health services for the general and infant populations found effectiveness on 40% of 30 outcomes analyzed. Concerning screening services for hypertension, diabetes, and cervical and prostate cancer, we found three studies evaluating 14 outcomes and finding significant effects on 50% of them. Studies looking at the impact of SP on diabetes, hypertension, and general health care and treatment evaluated 19 outcomes and found effects on 21% of them. One study assessed five diabetes monitoring services and found positive effects on four of them. The only study on morbidity and mortality found positive results on three of the four outcomes of interest. CONCLUSION We found mixed evidence on the impact of SP on financial protection, healthcare utilization, morbidity and mortality. In the 26 studies included in this review, researchers found positive effects in roughly half of the outcomes and null results on the rest.
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Affiliation(s)
- M A Colchero
- Center for Health Systems Research, Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - R Gómez
- Center for Health Systems Research, Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, C.P. 62100, Cuernavaca, Morelos, Mexico
| | - S Bautista-Arredondo
- Center for Health Systems Research, Instituto Nacional de Salud Pública, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, C.P. 62100, Cuernavaca, Morelos, Mexico.
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Mendivil CO, Amaya-Montoya M, Hernández-Vargas JA, Ramírez-García N, Romero-Díaz C, Pérez-Londoño A, Guatibonza-García V, Acuña-Merchán L. Achievement of treatment goals among adults with diabetes in Colombia, 2015-2019: Results from a national registry. Diabetes Res Clin Pract 2022; 186:109823. [PMID: 35271878 DOI: 10.1016/j.diabres.2022.109823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 02/09/2023]
Abstract
AIMS To assess the achievement of essential treatment goals among patients with diabetes in Colombia. METHODS We analyzed data from a nationwide registry of all individuals with diagnosed diabetes, hypertension or CKD assisted by the health system. We explored the prevalence of treatment goals (HbA1c < 7% [<53 mmol/mol], systolic blood pressure (SBP) < 130 mmHg and LDLc < 100 mg/dL), and their variations by race and type of health insurance, between July 1, 2015, and June 30, 2019. RESULTS We studied 1 352 846 patients with diagnosed diabetes. The prevalence of HbA1c < 7% (<53 mmol/mol) remained steady at 52%, systolic blood pressure (SBP) < 130 mmHg was also stable at 80-82%. Meanwhile, the prevalence of both LDLc < 100 mg/dL and non-HDLc < 130 mg/dL increased by 6 percentage points. Achievement of the triple HbA1c + SBP + LDLc goal was only 21.4% in 2015, increasing to 24.4% by 2019. Goal achievement was consistently lower among patients of black race, especially for HbA1c (5% lower than other races), but also for the SBP, LDLc and joint goals. Patients under third-party insurance reached better HbA1c, SBP, and LDLc control. CONCLUSIONS Achievement of treatment goals of patients with diabetes in Colombia remains substantially low, despite improvements in LDLc control.
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Affiliation(s)
- Carlos O Mendivil
- School of Medicine, Universidad de los Andes, Bogotá, Colombia; Endocrinology Section, Department of Internal Medicine, Fundación Santa Fe de Bogotá, Bogotá, Colombia.
| | | | | | | | | | | | | | - Lizbeth Acuña-Merchán
- Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Bogotá, Colombia
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Fernández Guerrico S. The effects of trade-induced worker displacement on health and mortality in Mexico. JOURNAL OF HEALTH ECONOMICS 2021; 80:102538. [PMID: 34634695 DOI: 10.1016/j.jhealeco.2021.102538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 08/23/2021] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
Recent research in the U.S. links trade-induced job displacement to deaths of despair. Should we expect the same mortality response in developing countries? This paper analyzes the effect of a trade-induced negative shock to manufacturing employment on leading causes of mortality in Mexico between 1998 and 2013. I exploit cross-municipality variation in trade exposure based on differences in industry specialization before China's accession to the WTO in 2001 to identify labor-demand shocks that are concentrated in manufacturing. I find trade-induced job loss increased mortality from diabetes, raised obesity rates, reduced physical activity, and lowered access to health insurance. These deaths were offset by declines in mortality from ischemic heart disease and chronic pulmonary disease. These findings highlight that negative employment shocks have heterogeneous impacts on mortality in developing countries, where falling incomes lead to less access to health care and nutritious food, but also reduce alcohol and tobacco use.
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Affiliation(s)
- Sofía Fernández Guerrico
- Université Libre de Bruxelles, Department of Applied Economics (Dulbea), Avenue Franklin Roosevelt 50, Brussels 1050, Belgium.
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Urina-Jassir M, Herrera-Parra LJ, Hernández Vargas JA, Valbuena-García AM, Acuña-Merchán L, Urina-Triana M. The effect of comorbidities on glycemic control among Colombian adults with diabetes mellitus: a longitudinal approach with real-world data. BMC Endocr Disord 2021; 21:128. [PMID: 34174843 PMCID: PMC8235812 DOI: 10.1186/s12902-021-00791-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/08/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Achieving an optimal glycemic control has been described to reduce the incidence of diabetes mellitus (DM) related complications. The association between comorbidities and glycemic control remains unclear. Our aim is to evaluate the effect of comorbidities on glycemic control in people living with DM. METHODS A retrospective longitudinal study on data from the National Registry of Chronic Kidney Disease from 2014 to 2019 in Colombia. The outcome was poor glycemic control (PGC = HbA1c ≥7.0%). The association between each comorbidity (hypertension (HTN), chronic kidney disease (CKD) or obesity) and PGC was evaluated through multivariate mixed effects logistic regression models. The measures of effect were odds ratios (OR) and their 95% confidence intervals (CI). We also evaluated the main associations stratified by gender, insurance, and early onset diabetes as well as statistical interaction between each comorbidity and ethnicity. RESULTS From 969,531 people at baseline, 85% had at least one comorbidity; they were older and mostly female. In people living with DM and CKD, the odds of having a PGC were 78% (OR: 1.78, CI 95%: 1.55-2.05) higher than those without CKD. Same pattern was observed in obese for whom the odds were 52% (OR: 1.52, CI 95%: 1.31-1.75) higher than in non-obese. Non-significant association was found between HTN and PGC. We found statistical interaction between comorbidities and ethnicity (afro descendant) as well as effect modification by health insurance and early onset DM. CONCLUSIONS Prevalence of comorbidities was high in adults living with DM. Patients with concomitant CKD or obesity had significantly higher odds of having a PGC.
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Affiliation(s)
- Manuel Urina-Jassir
- Fundación del Caribe para la Investigación Biomédica, Carrera 50 # 80 - 216 Office 201, Barranquilla, Atlántico, Colombia
| | - Lina Johana Herrera-Parra
- Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Carrera 45 # 103 - 34, Bogotá, D.C, Colombia
| | | | - Ana María Valbuena-García
- Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Carrera 45 # 103 - 34, Bogotá, D.C, Colombia
| | - Lizbeth Acuña-Merchán
- Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Carrera 45 # 103 - 34, Bogotá, D.C, Colombia
| | - Miguel Urina-Triana
- Fundación del Caribe para la Investigación Biomédica, Carrera 50 # 80 - 216 Office 201, Barranquilla, Atlántico, Colombia.
- Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Carrera 59 # 59 - 65, Barranquilla, 080002, Colombia.
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Genberg BL, Wachira J, Steingrimsson JA, Pastakia S, Tran DNT, Said JA, Braitstein P, Hogan JW, Vedanthan R, Goodrich S, Kafu C, Wilson-Barthes M, Galárraga O. Integrated community-based HIV and non-communicable disease care within microfinance groups in Kenya: study protocol for the Harambee cluster randomised trial. BMJ Open 2021; 11:e042662. [PMID: 34006540 PMCID: PMC8137246 DOI: 10.1136/bmjopen-2020-042662] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION In Kenya, distance to health facilities, inefficient vertical care delivery and limited financial means are barriers to retention in HIV care. Furthermore, the increasing burden of non-communicable diseases (NCDs) among people living with HIV complicates chronic disease treatment and strains traditional care delivery models. Potential strategies for improving HIV/NCD treatment outcomes are differentiated care, community-based care and microfinance (MF). METHODS AND ANALYSIS We will use a cluster randomised trial to evaluate integrated community-based (ICB) care incorporated into MF groups in medium and high HIV prevalence areas in western Kenya. We will conduct baseline assessments with n=900 HIV positive members of 40 existing MF groups. Group clusters will be randomised to receive either (1) ICB or (2) standard of care (SOC). The ICB intervention will include: (1) clinical care visits during MF group meetings inclusive of medical consultations, NCD management, distribution of antiretroviral therapy (ART) and NCD medications, and point-of-care laboratory testing; (2) peer support for ART adherence and (3) facility referrals as needed. MF groups randomised to SOC will receive regularly scheduled care at a health facility. Findings from the two trial arms will be compared with follow-up data from n=300 matched controls. The primary outcome will be VS at 18 months. Secondary outcomes will be retention in care, absolute mean change in systolic blood pressure and absolute mean change in HbA1c level at 18 months. We will use mediation analysis to evaluate mechanisms through which MF and ICB care impact outcomes and analyse incremental cost-effectiveness of the intervention in terms of cost per HIV suppressed person-time, cost per patient retained in care and cost per disability-adjusted life-year saved. ETHICS AND DISSEMINATION The Moi University Institutional Research and Ethics Committee approved this study (IREC#0003054). We will share data via the Brown University Digital Repository and disseminate findings via publication. TRIAL REGISTRATION NUMBER NCT04417127.
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Affiliation(s)
- Becky L Genberg
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Juddy Wachira
- Behavioral Sciences, Moi University College of Health Sciences, School of Medicine, Eldoret, Kenya
| | - Jon A Steingrimsson
- Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Sonak Pastakia
- Center for Health Equity and Innovation, Purdue University College of Pharmacy, Indianapolis, Indiana, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Dan N Tina Tran
- Center for Health Equity and Innovation, Purdue University College of Pharmacy, Indianapolis, Indiana, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jamil AbdulKadir Said
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Internal Medicine, Moi University School of Medicine, Eldoret, Kenya
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Joseph W Hogan
- Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Rajesh Vedanthan
- Global Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Suzanne Goodrich
- Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Catherine Kafu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Marta Wilson-Barthes
- Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Omar Galárraga
- Health Services, Policy and Practice, Brown University School of Public Health, 121 South Main St. Box G-S121-2 Providence, Rhode Island, USA
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Incidence of catastrophic healthcare expenditure and its main determinants in Mexican households caring for a person with a mental disorder. Glob Ment Health (Camb) 2021; 8:e2. [PMID: 33889419 PMCID: PMC8057364 DOI: 10.1017/gmh.2020.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 11/14/2020] [Accepted: 12/03/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There are few studies on the impact of out-of-pocket mental health care expenditures and sociodemographic factors on the probability of Mexican households to incur catastrophic healthcare expenditures (CHE). OBJECTIVE The goal of the present study was to estimate the incidence of CHE and its main determinants among the households of persons with mental disorders (MD) in Mexico. METHODS A cross-sectional survey was conducted, including 387 households of persons with MD. The estimation of the CHE was obtained by the health expenditure distribution method. A Logistic Regression (LR) was used to identify the determinants of probability variation of CHE occurrence. Since we expected a proportion of CHE between 20% and 80%, we assume linearity in the probability function, therefore we additionally used an Ordinary Least Squares (OLS) model. RESULTS In our sample, the incidence of CHE was 34.8%. The two mental illnesses most frequently associated with CHE were schizophrenia and hyperactive disorder (35.5% and 32.6% of CHE cases, respectively). The regression coefficients showed that for each unit (US$53.77) increase in income, the probability of CHE was reduced by 8.6%, while for each unit increase in hospitalization or medication expenditures, the probability of CHE increased by 12.9% or 19%, respectively. For each additional household member, the probability of CHE increased by 3%, and households with a male patient had a 7% greater probability of CHE. CONCLUSION Household income, household size, hospitalization and medication expenses, and sex of the patient were significant predictors of CHE for households caring for a person with MD.
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Dieteren CM, O'Donnell O, Bonfrer I. Prevalence and inequality in persistent undiagnosed, untreated, and uncontrolled hypertension: Evidence from a cohort of older Mexicans. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000114. [PMID: 36962148 PMCID: PMC10021230 DOI: 10.1371/journal.pgph.0000114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/18/2021] [Indexed: 12/21/2022]
Abstract
Hypertension is the leading risk factor for cardiovascular diseases (CVDs) and substantial gaps in diagnosis, treatment and control signal failure to avert premature deaths. Our aim was to estimate the prevalence and assess the socioeconomic distribution of hypertension that remained undiagnosed, untreated, and uncontrolled for at least five years among older Mexicans and to estimate rates of transition from those states to diagnosis, treatment and control. We used data from a cohort of Mexicans aged 50+ in two waves of the WHO Study on Global AGEing and adult health (SAGE) collected in 2009 and 2014. Blood pressure was measured, hypertension diagnosis and treatment self-reported. We estimated prevalence and transition rates over five years and calculated concentration indices to identify socioeconomic inequalities using a wealth index. Using probit models, we identify characteristics of those facing the greatest barriers in receiving hypertension care. More than 60 percent of individuals with full item response (N = 945) were classified as hypertensive. Over one third of those undiagnosed continued to be in that state five years later. More than two fifths of those initially untreated remained so, and over three fifths of those initially uncontrolled failed to achieve continued blood pressure control. While being classified as hypertensive was more concentrated among the rich, missing diagnosis, treatment and control were more prevalent among the poor. Men, singles, rural dwellers, uninsured, and those with overweight were more likely to have persistent undiagnosed, untreated, and uncontrolled hypertension. There is room for improvement in both hypertension diagnosis and treatment in Mexico. Clinical and public health attention is required, even for those who initially had their hypertension controlled. To ensure more equitable hypertension care and effectively prevent premature deaths, increased diagnosis and long-term treatment efforts should especially be directed towards men, singles, uninsured, and those with overweight.
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Affiliation(s)
- C M Dieteren
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - O O'Donnell
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Faculty of Business and Economics, University of Lausanne, Lausanne, Switzerland
| | - I Bonfrer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Health-care coverage and access to health care in the context of type 2 diabetes and hypertension in rural Mexico: a systematic literature review. Public Health 2020; 181:8-15. [PMID: 31918156 DOI: 10.1016/j.puhe.2019.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 10/22/2019] [Accepted: 11/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We aimed to identify the coverage rates and use of health care and to explore barriers and facilitators of access in rural Mexico. STUDY DESIGN Systematic review of the literature. METHODS We undertook a structured search in the electronic databases EMBASE, Medline, and Scopus. Inclusion criteria comprised articles published in Spanish and English during the period 1986-2018. The studies were screened and selected by two independent reviewers in accordance with predefined criteria. RESULTS The review included 14 studies. Over the last 30 years, the rates of health-care coverage have increased from 30% to >50% in rural Mexico. Although the rates of health-care coverage increased, aspects such as lack of resources, language, and health-care professionals remained important barriers to health care. Cash transfer programs were identified as a facilitator. CONCLUSIONS Despite increased health-care coverage of >50% in the last three decades, action is needed to fulfill the needs of rural Mexican populations. It is important to increase the number of trained health professionals who practice in rural areas. Moreover, health programs should be developed and adapted to meet the needs of rural and indigenous populations.
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Riumallo-Herl C, Aguila E. The effect of old-age pensions on health care utilization patterns and insurance uptake in Mexico. BMJ Glob Health 2019; 4:e001771. [PMID: 31798987 PMCID: PMC6861075 DOI: 10.1136/bmjgh-2019-001771] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/05/2019] [Accepted: 10/12/2019] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION As old-age pensions continue to expand around the world in response to population ageing, policymakers increasingly wish to understand their impact on healthcare demand. In this paper, we examine the effects of supplemental income to older adults on healthcare use patterns, expenditures and insurance uptake in Yucatan, Mexico. METHOD We use a longitudinal survey for individuals aged 70 or older and an individual fixed-effects difference-in-difference approach to understand the effect of an income supplement on healthcare use patterns, out-of-pocket expenditures and health insurance uptake patterns. RESULTS The implementation of the old-age pension was associated with increased use of healthcare with nuanced effects on the type of care. Old-age pensions increase the use of formal healthcare by 15 percentage points (95% CI 6.1 to 23.9) for those with healthcare use at baseline and by 7.5 percentage points (95% CI 3.7 to 11.3) for those without healthcare use at baseline. We find no evidence of greater out-of-pocket expenditures, likely because old-age pensions were associated with a 4.2 percentage point (95% CI 1.5 to 6.9) increase in use of public health insurance. CONCLUSION Old-age pensions can shift healthcare demand towards formal services and eliminate financial barriers to basic care. Pension benefits can also increase the uptake of insurance programmes. These results demonstrate how social programmes can complement each other This highlights the potential role of old-age pensions in achieving universal health coverage for individuals at older ages.
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Affiliation(s)
| | - Emma Aguila
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
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Gómez-Dantés O, Frenk J. Financing Common Goods: The Mexican System for Social Protection in Health Agenda. Health Syst Reform 2019; 5:382-386. [PMID: 31592710 DOI: 10.1080/23288604.2019.1648736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Octavio Gómez-Dantés
- Center for Health Systems Research, National Institute of Public Health, Ljubljana, Mexico
| | - Julio Frenk
- President, University of Miami, Coral Gables, FL, USA.,Minister of Health of Mexico (2000-2006)
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Qin VM, Hone T, Millett C, Moreno-Serra R, McPake B, Atun R, Lee JT. The impact of user charges on health outcomes in low-income and middle-income countries: a systematic review. BMJ Glob Health 2019; 3:e001087. [PMID: 30792908 PMCID: PMC6350744 DOI: 10.1136/bmjgh-2018-001087] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/15/2018] [Accepted: 11/06/2018] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND User charges are widely used health financing mechanisms in many health systems in low-income and middle-income countries (LMICs) due to insufficient public health spending on health. This study systematically reviews the evidence on the relationship between user charges and health outcomes in LMICs, and explores underlying mechanisms of this relationship. METHODS Published studies were identified via electronic medical, public health, health services and economics databases from 1990 to September 2017. We included studies that evaluated the impact of user charges on health in LMICs using randomised control trial (RCT) or quasi-experimental (QE) study designs. Study quality was assessed using Cochrane Risk of Bias and Risk of Bias in Non-Randomized Studies-of Intervention for RCT and QE studies, respectively. RESULTS We identified 17 studies from 12 countries (five upper-middle income countries, five lower-middle income countries and two low-income countries) that met our selection criteria. The findings suggested a modest relationship between reduction in user charges and improvements in health outcomes, but this depended on health outcomes measured, the populations studied, study quality and policy settings. The relationship between reduced user charges and improved health outcomes was more evident in studies focusing on children and lower-income populations. Studies examining infectious disease-related outcomes, chronic disease management and nutritional outcomes were too few to draw meaningful conclusions. Improved access to healthcare as a result of reduction in out-of-pocket expenditure was identified as the possible causal pathway for improved health. CONCLUSIONS Reduced user charges were associated with improved health outcomes, particularly for lower-income groups and children in LMICs. Accelerating progress towards universal health coverage through prepayment mechanisms such as taxation and insurance can lead to improved health outcomes and reduced health inequalities in LMICs. TRIAL REGISTRATION NUMBER CRD 42017054737.
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Affiliation(s)
- Vicky Mengqi Qin
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Thomas Hone
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | | | - Barbara McPake
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - John Tayu Lee
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Rivera-Hernández M, Rahman M, Galárraga O. Preventive healthcare-seeking behavior among poor older adults in Mexico: the impact of Seguro Popular, 2000-2012. SALUD PUBLICA DE MEXICO 2019; 61:46-53. [PMID: 30753772 PMCID: PMC6561080 DOI: 10.21149/9185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/25/2018] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Determine the effect of Seguro Popular (SP) on preventive care utilization among low-income SP beneficiaries and uninsured elders in Mexico. MATERIALS AND METHODS Fixed-effects instrumental-variable (FE-IV) pseudo-panel estimation from three rounds of the Mexican National Health and Nutrition Survey (2000, 2006 and 2012). RESULTS Our findings suggest that SP has no significant effect on the use of preventive services, including screening for diabetes, hypertension, breast cancer and cervical cancer, by adults aged 50 to 75 years. CONCLUSIONS Despite the evidence that suggests that SP has increased access to health insurance for the poor, inequalities in healthcare access and utilization still exist in Mexico. The Mexican government must keep working on extending health insurance coverage to vulnerable adults. Additional efforts to increase health care coverage and to support preventive care are needed to reduce persistent disparities in healthcare utilization.
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Affiliation(s)
| | - Momotazur Rahman
- Department of Health Services, Policy and Practice, Brown University. Providence, Rhode Island, USA
| | - Omar Galárraga
- Department of Health Services, Policy and Practice, Brown University. Providence, Rhode Island, USA
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Avila JC, Kaul S, Wong R. Health Care Expenditures and Utilization Among Older Mexican Adults. J Aging Health 2018; 32:269-277. [PMID: 30547690 DOI: 10.1177/0898264318818901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Examine differences in health care utilization and out-of-pocket (OOP) expenditures among older Mexican adults in 2001 and 2012, and identify individual characteristics associated with utilization and expenditures in both years. Method: Data from the 2001 and 2012 cross-sections of the Mexican Health and Aging Study were utilized. Outcomes included nights spent in the hospital, medical/outpatient procedures, and OOP expenditures with these services. Covariates included demographics and comorbidities. Two-part regression models were used to identify covariates associated with utilization and expenditures in each year. Results: The proportion of those who spent at least one night in the hospital or had at least one medical/outpatient visit was higher in 2012 than in 2001, while the proportion of individuals with OOP expenditures decreased between the years. Those with more comorbidities had the highest OOP expenditures in both years. Discussion: Although the population paying for health care services OOP was lower in 2012, there is persistent inequality in expenditures across population groups.
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Affiliation(s)
- Jaqueline C Avila
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, USA
| | - Sapna Kaul
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, USA
| | - Rebeca Wong
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, USA
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20
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Political party ambitions and type-2 diabetes policy in Brazil and Mexico. HEALTH ECONOMICS POLICY AND LAW 2018; 15:261-276. [PMID: 30394254 DOI: 10.1017/s1744133118000415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the Americas, next to the United States, Brazil and Mexico have the highest prevalence of type-2 diabetes. In contrast to most studies, this article compares and analyzes the politics behind the implementation of type-2 diabetes self-care management programs (DSM), which is a new area of scholarly research. This article claims that Brazil outpaced Mexico with respect to the implementation of effective DSM programs, the product of positive policy spillover effects associated with the president and governing political party's popular anti-poverty programs, and the enduring legacy of centralized ministry of health financial and human resource assistance to primary care programs in a context of decentralization. Brazil also benefited from having a strong partnership with international health agencies. None of these factors was present in Mexico. Findings suggest that more research needs to go into understanding the complex political and inter-governmental contexts facilitating DSM program implementation, which is a neglected area of research.
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Thomas H, Diamond J, Vieco A, Chaudhuri S, Shinnar E, Cromer S, Perel P, Mensah GA, Narula J, Johnson CO, Roth GA, Moran AE. Global Atlas of Cardiovascular Disease 2000-2016: The Path to Prevention and Control. Glob Heart 2018; 13:143-163. [PMID: 30301680 DOI: 10.1016/j.gheart.2018.09.511] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Hana Thomas
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jamie Diamond
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Adrianna Vieco
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Shaoli Chaudhuri
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Eliezer Shinnar
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Sara Cromer
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Pablo Perel
- World Heart Federation, Geneva, Switzerland; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - George A Mensah
- Center for Translation Research and Implementation Science, United States National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Jagat Narula
- Division of Cardiology, Mount Sinai Medical Center, New York, NY, USA
| | - Catherine O Johnson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Andrew E Moran
- Department of Medicine, Columbia University Medical Center, New York, NY, USA; Division of General Medicine, Columbia University, New York, NY, USA.
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22
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Doubova SV, Borja-Aburto VH, Guerra-Y-Guerra G, Salgado-de-Snyder VN, González-Block MÁ. Loss of job-related right to healthcare is associated with reduced quality and clinical outcomes of diabetic patients in Mexico. Int J Qual Health Care 2018; 30:283-290. [PMID: 29432612 DOI: 10.1093/intqhc/mzy012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/24/2018] [Indexed: 01/29/2023] Open
Abstract
Objectives The Mexican Institute of Social Security (IMSS) provides a package of health, economic and social benefits to workers employed in private firms within the formal labour market and to their economic dependants. Affiliates have a right to these benefits only while they remain contracted, thus posing a risk for the continuity of healthcare. This study evaluates the association between the time (in days) without the right to healthcare due to job loss in the formal labour market and the quality of healthcare and clinical outcomes among IMSS affiliates with Type 2 diabetes mellitus (T2DM). Design Retrospective cohort study 2013-2015. Setting Six IMSS family medicine clinics (FMC) in Mexico City. Participants T2DM patients (n = 27 217) affiliated with job-related health insurance and at least one consultation with a family doctor during 2013. Source of Information IMSS affiliation department database and electronic health records and clinical laboratory databases. Main Outcome Measure(s) Quality of the processes (eight indicators) and outcomes (three indicators) of healthcare. Results The results indicated that losing IMSS right to healthcare is frequent, occurring to one-third of T2DM patients during the follow-up period. The time without the right to healthcare in the observed period was of 120 days on average and was associated with a 43.2% loss of quality of care and a 19.2% reduction in clinical outcomes of T2DM. Conclusion Policies aimed at ensuring access and continuity of care, regardless of job status, are critical for improving the quality of processes and outcomes of healthcare for diabetic patients.
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Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit, CMN Siglo XXI, Mexican Institute of Social Security, Av. Cuauhtemoc 330, Mexico City 06720, Mexico
| | - Víctor Hugo Borja-Aburto
- Unidad de Salud Pública, Instituto Mexicano del Seguro Social, Hamburgo 18, Mexico City 06700, Mexico City, Mexico
| | - Germán Guerra-Y-Guerra
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Av. Universidad #655, Santa María Ahuacatitlán, 62100 Cuernavaca, Mor., México
| | - V Nelly Salgado-de-Snyder
- Instituto Nacional de Salud Pública, Av. Universidad #655, Santa María Ahuacatitlán, 62100 Cuernavaca, Mor., México
| | - Miguel Ángel González-Block
- Cátedra PwC de Investigación en Sistemas de Salud, Facultad de Ciencias de la Salud, Universidad Anáhuac, Av Universidad Anáhuac #46, Lomas Anahuac, 52786 Naucalpan de Juárez, Méx., Mexico
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García-Díaz R, Sosa-Rubí SG, Serván-Mori E, Nigenda G. Welfare effects of health insurance in Mexico: The case of Seguro Popular de Salud. PLoS One 2018; 13:e0199876. [PMID: 29965976 PMCID: PMC6028097 DOI: 10.1371/journal.pone.0199876] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/18/2018] [Indexed: 11/19/2022] Open
Abstract
This study contributes with original empirical evidence on the distributional and welfare effects of one of the most important health policies implemented by the Mexican government in the last decade, the Seguro Popular de Salud (SPS). We analyze the effect of SPS on households' welfare using a decomposable index that considers insured and uninsured households' response to out-of-pocket (OOP) payments using both social welfare weights and inequality aversion. The disaggregation of the welfare index allows us to explore the heterogeneity of the SPS impact on households' welfare. We applied propensity score matching to reduce the self-selection bias of being SPS insured. Overall results suggest non-conclusive results of the impact of SPS on households' welfare. When we disaggregated the welfare index by different sub-population groups, our results suggest that households' beneficiaries of SPS with older adults or living in larger cities are better protected against OOP health care payments than their uninsured counterparts. However, no effect was found among SPS-insured households living in rural and smaller cities, which is a result that could be attributed to limited access to health resources in these regions. Scaling up health insurance coverage is a necessary but not sufficient condition to ensure the protection of SPS coverage against financial risks among the poor.
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Affiliation(s)
- Rocío García-Díaz
- Department of Economics, Monterrey Institute of Technology and Higher Education, Nuevo León, México
| | - Sandra G. Sosa-Rubí
- Center for Health Systems Research, National Institute of Public Health, Morelos, México
| | - Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Morelos, México
| | - Gustavo Nigenda
- National School of Nursing and Obstetrics, National Autonomous University of México, México City, México
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Ong SE, Koh JJK, Toh SAES, Chia KS, Balabanova D, McKee M, Perel P, Legido-Quigley H. Assessing the influence of health systems on Type 2 Diabetes Mellitus awareness, treatment, adherence, and control: A systematic review. PLoS One 2018; 13:e0195086. [PMID: 29596495 PMCID: PMC5875848 DOI: 10.1371/journal.pone.0195086] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/18/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Type 2 Diabetes Mellitus (T2DM) is reported to affect one in 11 adults worldwide, with over 80% of T2DM patients residing in low-to-middle-income countries. Health systems play an integral role in responding to this increasing global prevalence, and are key to ensuring effective diabetes management. We conducted a systematic review to examine the health system-level factors influencing T2DM awareness, treatment, adherence, and control. METHODS AND FINDINGS A protocol for this study was published on the PROSPERO international prospective register of systematic reviews (PROSPERO 2016: CRD42016048185). Studies included in this review reported the effects of health systems factors, interventions, policies, or programmes on T2DM control, awareness, treatment, and adherence. The following databases were searched on 22 February 2017: Medline, Embase, Global health, LILACS, Africa-Wide, IMSEAR, IMEMR, and WPRIM. There were no restrictions on date, language, or study designs. Two reviewers independently screened studies for eligibility, extracted the data, and screened for risk of bias. Thereafter, we performed a narrative synthesis. A meta-analysis was not conducted due to methodological heterogeneity across different aspects of included studies. 93 studies were included for qualitative synthesis; 7 were conducted in LMICs. Through this review, we found two key health system barriers to effective T2DM care and management: financial constraints faced by the patient and limited access to health services and medication. We also found three health system factors that facilitate effective T2DM care and management: the use of innovative care models, increased pharmacist involvement in care delivery, and education programmes led by healthcare professionals. CONCLUSIONS This review points to the importance of reducing, or possibly eliminating, out-of-pocket costs for diabetes medication and self-monitoring supplies. It also points to the potential of adopting more innovative and integrated models of care, and the value of task-sharing of care with pharmacists. More studies which identify the effect of health system arrangements on various outcomes, particularly awareness, are needed.
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Affiliation(s)
- Suan Ee Ong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Joel Jun Kai Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sue-Anne Ee Shiow Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Dina Balabanova
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- World Heart Federation, Geneva, Switzerland
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Knaul FM, Arreola-Ornelas H, Wong R, Lugo-Palacios DG, Méndez-Carniado O. Efecto del Seguro Popular de Salud sobre los gastos catastróficos y empobrecedores en México, 2004-2012. ACTA ACUST UNITED AC 2018; 60:130-140. [DOI: 10.21149/9064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/25/2018] [Indexed: 11/06/2022]
Abstract
Objetivos. Determinar el impacto del Seguro Popular (SPS) en los gastos catastróficos y empobrecedores de los hogares y la protección financiera del sistema de salud en México. Material y métodos. Se aplicó el método de pareo por puntaje de propensión sobre la afiliación al SPS y se determinó el efecto atribuible en el gasto en salud. Se hizo uso de la Encuesta Nacional de Ingresos y Gastos de los Hogares (ENIGH) de 2004 a 2012, del Instituto Nacional de Estadística y Geografía. Resultados. El SPS tiene un efecto significativo reductor en la probabilidad de sufrir gastos empobrecedores. En lo que respecta a los gastos catastróficos hubo reducción sin ser significativa entre grupos. Conclusión. Este estudio demuestra el efecto que el SPS, y en particular el aseguramiento en salud, tiene como un instrumento de protección financiera. Para futuros estudios se propone analizar la persistencia del alto porcentaje del gasto de bolsillo aprovechando series de tiempo más largas de la ENIGH.
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Newman PM, Franke MF, Arrieta J, Carrasco H, Elliott P, Flores H, Friedman A, Graham S, Martinez L, Palazuelos L, Savage K, Tymeson H, Palazuelos D. Community health workers improve disease control and medication adherence among patients with diabetes and/or hypertension in Chiapas, Mexico: an observational stepped-wedge study. BMJ Glob Health 2018. [PMID: 29527344 PMCID: PMC5841495 DOI: 10.1136/bmjgh-2017-000566] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Non-communicable diseases (NCDs) contribute greatly to morbidity and mortality in low-income and middle-income countries (LMICs). Community health workers (CHWs) may improve disease control and medication adherence among patients with NCDs in LMICs, but data are lacking. We assessed the impact of a CHW-led intervention on disease control and adherence among patients with diabetes and/or hypertension in Chiapas, Mexico. Methods We conducted a prospective observational study among adult patients with diabetes and/or hypertension, in the context of a stepped-wedge roll-out of a CHW-led intervention. We measured self-reported adherence to medications, blood pressure and haemoglobin A1c at baseline and every 3 months, timed just prior to expansion of the intervention to a new community. We conducted individual-level mixed effects analyses of study data, adjusting for time and clustering by patient and community. Findings We analysed 108 patients. The CHW-led intervention was associated with a twofold increase in the odds of disease control (OR 2.04, 95% CI 1.15 to 3.62). It was also associated with optimal adherence assessed by 30-day recall (OR 1.86; 95% CI 1.15 to 3.02) and a positive self-assessment of adherence behaviour (OR 2.29; 95% CI 1.26 to 4.15), but not by 5-day recall. Interpretation A CHW-led adherence intervention was associated with disease control and adherence among adults with diabetes and/or hypertension. This study supports a role of CHWs in supplementing comprehensive primary care for patients with NCDs in LMICs. Trial registration number NCT02549495.
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Affiliation(s)
- Patrick M Newman
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Molly F Franke
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Jafet Arrieta
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Hector Carrasco
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Patrick Elliott
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hugo Flores
- Compañeros en Salud, Angel Albino Corzo, Chiapas, Mexico
| | - Alexandra Friedman
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - Luis Martinez
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Kevin Savage
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Hayley Tymeson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Parker SW, Saenz J, Wong R. Health Insurance and the Aging: Evidence From the Seguro Popular Program in Mexico. Demography 2018; 55:361-386. [PMID: 29357097 PMCID: PMC5829015 DOI: 10.1007/s13524-017-0645-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aimed at covering the large fraction of workers in the informal sector without access to a social security program, the Mexican public health insurance program Seguro Popular began in 2002 and now reaches more than 50 million individuals. We estimate impacts of Seguro Popular for the population aged 50 and older on a set of indicators related to health care including utilization, diagnostic/preventive tests, and treatment conditional on being ill. Using the longitudinal Mexican Health and Aging Study over the period 2001-2012, we conduct before and after difference-in-difference matching impact estimators. Our results suggest large and important effects of the Program on utilization and diagnostic tests. We find overall smaller effects on the probability of being in treatment for individuals with chronic diseases, but these effects are concentrated in rural areas with relatively more health services versus rural areas with lower levels of health services. These results suggest that, to the extent that health services become more available in rural areas lacking services, effects of health insurance may increase.
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Affiliation(s)
- Susan W Parker
- School of Public Policy, University of Maryland, 2101 Van Munching Hall, College Park, MD, 20742, USA.
- Centro de Investigación y Docencia Económicas (CIDE), Carretera Mexico Toluca 3655, Mexico, DF, Mexico.
| | - Joseph Saenz
- University of Southern California, 3715 McClintock Avenue, Los Angeles, CA, 90089-0191, USA
| | - Rebeca Wong
- University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-0177, USA
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Ascencio-Montiel IDJ. 10 years Analysis of Diabetes-related Major Lower Extremity Amputations in Mexico. Arch Med Res 2018; 49:58-64. [DOI: 10.1016/j.arcmed.2018.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 04/06/2018] [Indexed: 11/26/2022]
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Rivera-Hernandez M, Rahman M, Mor V, Galarraga O. The Impact of Social Health Insurance on Diabetes and Hypertension Process Indicators among Older Adults in Mexico. Health Serv Res 2017; 51:1323-46. [PMID: 27417264 DOI: 10.1111/1475-6773.12404] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the impact of Seguro Popular (Mexican social health insurance for the poor; SP) on diabetes and hypertension care, intermediate process indicators for older adults (>50 years): pharmacological treatment, blood glucose tests, the use of complementary and alternative medicine (CAM), and adherence to their nutrition and exercise program. (CAM was defined as products or practices that were not part of the medical standard of care.) DATA SOURCES/STUDY SETTING Repeated cross-sectional surveys from Encuesta Nacional de Salud y Nutrición (Mexican Health and Nutrition Survey, ENSANUT), a nationally representative health and nutrition survey sampling N = 45,294 older adults in 2000, N = 45,241 older adults in 2005-2006, and N = 46,277 older adults in 2011-2012. STUDY DESIGN Fixed-effects instrumental variable (FE-IV) repeated cross-sectional at the individual level with municipality fixed-effects estimation was performed. PRINCIPAL FINDINGS We found a marginally significant effect of SP on the use of insulin and oral agents (40 percentage points). Contrary to that expected, no other significant differences were found for diabetes or hypertension treatment and care indicators. CONCLUSIONS Social health insurance for the poor improved some but not all health care process indicators among diabetic and hypertensive older people in Mexico.
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Affiliation(s)
| | - Momotazur Rahman
- Department of Health Services, Policy and Practice, Brown University, Providence, RI
| | - Vincent Mor
- Department of Health Services, Policy and Practice, Brown University, Providence, RI
| | - Omar Galarraga
- Department of Health Services, Policy and Practice, Brown University, Providence, RI
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30
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Montesi L. "Como Si Nada": Enduring Violence and Diabetes among Rural Women in Southern Mexico. Med Anthropol 2017; 37:206-220. [PMID: 28409673 DOI: 10.1080/01459740.2017.1313253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Rural women in Southern Mexico link their diabetes to distressful life experiences rooted in ordinary violence. While much has been written on the use that diabetes sufferers make of their morbid condition as an idiom of distress, I investigate the personal and social effects that such an idiom has on women. As I illustrate, diabetes reflects an ambivalence that helps women to speak about the unspeakable and, at the same time, reinforces their ideas of culpability, namely that they are to blame for both the gendered violence that they endure and the diabetes from which they suffer.
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Affiliation(s)
- Laura Montesi
- a School of Anthropology and Conservation , The University of Kent , Canterbury , Kent , United Kingdom
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Beltrán-Sánchez H, Drumond-Andrade FC, Riosmena F. Contribution of socioeconomic factors and health care access to the awareness and treatment of diabetes and hypertension among older Mexican adults. SALUD PUBLICA DE MEXICO 2017; 57 Suppl 1:S6-14. [PMID: 26172227 DOI: 10.21149/spm.v57s1.7584] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 05/27/2014] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To estimate changes in self-report and treatment of diabetes and hypertension between 2001 and 2012 among Mexican aged 50-80, assessing the contribution of education and health insurance coverage. MATERIALS AND METHODS The Mexican Health and Aging Study was used to estimate associations of education and insurance on prevalence and treatment of diabetes and hypertension in 2001 and 2012. Multivariate decomposition was used to assess the contribution of changes in the composition of covariates vs. their "effects" on changes in prevalence and treatment over time. RESULTS Increases in the prevalence/diagnosis and treatment during the period are largely attributable to the expansion of health insurance. Its effects on diagnosis/prevalence and treatment have also increased over time. CONCLUSIONS The expansion of Seguro Popular likely improved screening and treatment. More research is needed to assess if these have translated into better control and a lower burden of disease.
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Affiliation(s)
- Hiram Beltrán-Sánchez
- Center for Demography and Ecology, University of Wisconsin-Madison, Madison, Wisconsin, Estados Unidos de América
| | - Flávia Cristina Drumond-Andrade
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaigne, Illinois, Estados Unidos de América
| | - Fernando Riosmena
- Geography Department, University of Colorado, Boulder, Colorado, Estados Unidos de América
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Aburto JM, Beltrán-Sánchez H, García-Guerrero VM, Canudas-Romo V. Homicides In Mexico Reversed Life Expectancy Gains For Men And Slowed Them For Women, 2000-10. Health Aff (Millwood) 2017; 35:88-95. [PMID: 26733705 DOI: 10.1377/hlthaff.2015.0068] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Life expectancy in Mexico increased for more than six decades but then stagnated in the period 2000-10. This decade was characterized by the enactment of a major health care reform-the implementation of the Seguro Popular de Salud (Popular Health Insurance), which was intended to provide coverage to the entire Mexican population-and by an unexpected increase in homicide mortality. We assessed the impact on life expectancy of conditions amenable to medical service-those sensitive to public health policies and changes in behaviors, homicide, and diabetes-by analyzing mortality trends at the state level. We found that life expectancy among males deteriorated from 2005 to 2010, compared to increases from 2000 to 2005. Females in most states experienced small gains in life expectancy between 2000 and 2010. The unprecedented rise in homicides after 2005 led to a reversal in life expectancy increases among males and a slowdown among females in most states in the first decade of the twenty-first century.
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Affiliation(s)
- José Manuel Aburto
- José Manuel Aburto is a Max Planck Institute for Demographic Research fellow at the European Doctoral School of Demography, Sapienza University, in Rome, Italy
| | - Hiram Beltrán-Sánchez
- Hiram Beltrán-Sánchez is an assistant professor in the Department of Community Health Sciences and at the California Center for Population Research, both at the University of California, Los Angeles
| | - Victor Manuel García-Guerrero
- Victor Manuel García-Guerrero is a professor at the Center of Demographic, Urban, and Environmental Studies, El Colegio de México, in Mexico City
| | - Vladimir Canudas-Romo
- Vladimir Canudas-Romo is an associate professor at the Max-Planck Odense Center on Biodemography of Aging, University of Southern Denmark, in Odense
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Jiamjarasrangsi W, Attavorrarat S, Navicharern R, Aekplakorn W, Keesukphan P. Assessment of 5-year system-wide type 2 diabetes control measures in a Southeast Asian metropolis. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0801.264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Sparse information exists regarding the progress of the chronic care model (CCM) implementation for type 2 diabetes, at system-wide level for developing countries including Thailand.
Objective: We assessed the extent to which type 2 diabetes patients in Bangkok, Thailand report having received CCM-based services by using the Patient Assessment of Chronic Illness Care (PACIC).
Methods: One thousand type 2 diabetes patients from 64 healthcare facilities throughout Bangkok were randomly selected, data about the extent they have received CCM-based services, their dietary, physical activity, medication-taking behaviors, body mass index (BMI), and blood sugar control status were collected by a set of structured questionnaires and medical record abstraction.
Results: PACIC and self-management scores for patients receiving care from public hospitals and health centers were significantly higher than those from private hospitals. Being the primary care unit (PCU)-where the CCM implementation has been enforced since 2008 was significantly associated with higher PACIC scores for public hospitals. This was not the case for private hospitals. PCU status was significantly associated with better selfmanagement scores for patients in both public and private hospitals. However, variations in PACIC and selfmanagement scores did not reflect to BMI or glycemic control outcomes of the patients.
Conclusion: There is encouraging evidence of progress of CCM implementation for type 2 diabetes patients in Bangkok, Thailand. This had also resulted in improved self-management, but not physiological or metabolic outcomes.
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Affiliation(s)
- Wiroj Jiamjarasrangsi
- MD, PhD, Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand Thailand
- Department of Preventive and Social Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok 10330, Thailand
| | - Suwapiccha Attavorrarat
- Technical and Planning Division, Food and Drug Administration, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Rungrawee Navicharern
- Adult Nursing Program, Faculty of Nursing, Chulalongkorn University, Bangkok 10330, Thailand
| | - Wichai Aekplakorn
- Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Prasit Keesukphan
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Christiani Y, Dhippayom T, Chaiyakunapruk N. Assessing evidence of inequalities in access to medication for diabetic populations in low- and middle-income countries: a systematic review. Glob Health Action 2016; 9:32505. [PMID: 27938647 PMCID: PMC5148807 DOI: 10.3402/gha.v9.32505] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 11/02/2016] [Accepted: 11/04/2016] [Indexed: 11/18/2022] Open
Abstract
Background Inequalities in access to medications among people diagnosed with diabetes inlow- and middle-income countries (LMICs) is a public health concern since untreated diabetes can lead to severe complications and premature death. Objective To assess evidence of inequalities in access to medication for diabetes in adult populations of people with diagnosed diabetes in LMICs. Design We conducted a systematic review of the literature using the PRISMA-Equity guidelines. A search of five databases – PubMed, Cochrane, CINAHL, PsycINFO, and EMBASE – was conducted from inception to November 2015. Using deductive content analysis, information extracted from the selected articles was analysed according to the PRISMA-Equity guidelines, based on exposure variables (place of residence, race/ethnicity, occupation, gender, religion, education, socio-economic status, social capital, and others). Results Fifteen articles (seven quantitative and eight qualitative studies) are included in this review. There were inconsistent findings between studies conducted in different countries and regions although financial and geographic barriers generally contributed to inequalities in access to diabetes medications. The poor, those with relatively low education, and people living in remote areas had less access to diabetes medications. Furthermore, we found that the level of government political commitment through primary health care and in the provision of essential medicines was an important factor in promoting access to medications. Conclusions The review indicates that inequalities exist in accessing medication among diabetic populations, although this was not evident in all LMICs. Further research is needed to assess the social determinants of health and medication access for people with diabetes in LMICs.
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Affiliation(s)
- Yodi Christiani
- Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,CREDOS (Creative Development Strategies) Institute, Jakarta, Indonesia
| | - Teerapon Dhippayom
- Pharmaceutical Care Research Unit, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Nathorn Chaiyakunapruk
- Center of Pharmaceutical Outcomes Research, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.,School of Pharmacy, University of Wisconsin, Madison, WI, USA.,School of Population Health, University of Queensland, Brisbane, QLD, Australia;
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Downer B, Chen NW, Wong R, Markides KS. Self-Reported Health and Functional Characteristics of Mexican and Mexican American Adults Aged 80 and Over. J Aging Health 2016; 28:1239-55. [PMID: 27590800 PMCID: PMC5012298 DOI: 10.1177/0898264316656508] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To examine the health and functional characteristics of Mexican and Mexican American adults aged ≥80. METHOD Data came from Wave I (2001) and Wave III (2012) of the Mexican Health and Aging Study (MHAS), and Wave IV (2000-2001) and Wave VII (2010-2011) of the Hispanic Established Populations for Epidemiologic Studies of the Elderly (HEPESE). RESULTS In 2000-2001, diabetes, arthritis, hypertension, and stroke were higher in the HEPESE than in the MHAS. In the HEPESE, activities of daily living (ADL) difficulties and all health conditions, except heart attack, were greater in 2010-2011 than in 2000-2001. In the MHAS, hypertension and ADL difficulties were greater, and arthritis was lower in 2012 compared with 2001. In 2010-2011, all self-reported health conditions were higher in the HEPESE compared with the 2012 observation of the MHAS. DISCUSSION The observed differences may reflect worse health for Mexican Americans, health care access, reporting bias, and more selective survival to very old age in Mexico.
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Affiliation(s)
- Brian Downer
- University of Texas Medical Branch, Galveston, USA
| | - Nai-Wei Chen
- University of Texas Medical Branch, Galveston, USA
| | - Rebeca Wong
- University of Texas Medical Branch, Galveston, USA
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Sosa-Rubí SG. Is Being Insured Sufficient to Ensure Effective Access to Health Care among Poor People in Mexico in the Long Term? Health Serv Res 2016; 51:1319-22. [PMID: 27396344 DOI: 10.1111/1475-6773.12541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Sandra G Sosa-Rubí
- National Bureau of Economic Research, 1050 Massachusetts Ave., Cambridge, MA
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Lee ES, Vedanthan R, Jeemon P, Kamano JH, Kudesia P, Rajan V, Engelgau M, Moran AE. Quality Improvement for Cardiovascular Disease Care in Low- and Middle-Income Countries: A Systematic Review. PLoS One 2016; 11:e0157036. [PMID: 27299563 PMCID: PMC4907518 DOI: 10.1371/journal.pone.0157036] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/24/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The majority of global cardiovascular disease (CVD) burden falls on people living in low- and middle-income countries (LMICs). In order to reduce preventable CVD mortality and morbidity, LMIC health systems and health care providers need to improve the delivery and quality of CVD care. OBJECTIVES As part of the Disease Control Priorities Three (DCP3) Study efforts addressing quality improvement, we reviewed and summarized currently available evidence on interventions to improve quality of clinic-based CVD prevention and management in LMICs. METHODS We conducted a narrative review of published comparative clinical trials that evaluated efficacy or effectiveness of clinic-based CVD prevention and management quality improvement interventions in LMICs. Conditions selected a priori included hypertension, diabetes, hyperlipidemia, coronary artery disease, stroke, rheumatic heart disease, and congestive heart failure. MEDLINE and EMBASE electronic databases were systematically searched. Studies were categorized as occurring at the system or patient/provider level and as treating the acute or chronic phase of CVD. RESULTS From 847 articles identified in the electronic search, 49 met full inclusion criteria and were selected for review. Selected studies were performed in 19 different LMICs. There were 10 studies of system level quality improvement interventions, 38 studies of patient/provider interventions, and one study that fit both criteria. At the patient/provider level, regardless of the specific intervention, intensified, team-based care generally led to improved medication adherence and hypertension control. At the system level, studies provided evidence that introduction of universal health insurance coverage improved hypertension and diabetes control. Studies of system and patient/provider level acute coronary syndrome quality improvement interventions yielded inconclusive results. The duration of most studies was less than 12 months. CONCLUSIONS The results of this review suggest that CVD care quality improvement can be successfully implemented in LMICs. Most studies focused on chronic CVD conditions; more acute CVD care quality improvement studies are needed. Longer term interventions and follow-up will be needed in order to assess the sustainability of quality improvement efforts in LMICs.
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Affiliation(s)
- Edward S. Lee
- Department of Medicine, Division of Geriatric, Hospital, Palliative and General Internal Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, United States of America
| | - Rajesh Vedanthan
- Department of Medicine, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Panniyammakal Jeemon
- Centre for Control of Chronic Conditions, Public Health Foundation of India, Kerala, India
| | - Jemima H. Kamano
- Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Preeti Kudesia
- Health, Nutrition and Population Global Practice, The World Bank, Kathmandu, Nepal
| | | | - Michael Engelgau
- Center for Translation Research and Implementation Science, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Andrew E. Moran
- Department of Medicine, Division of General Medicine, Columbia University Medical Center, New York, New York, United States of America
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Kumar A, Wong R, Ottenbacher KJ, Al Snih S. Prediabetes, undiagnosed diabetes, and diabetes among Mexican adults: findings from the Mexican Health and Aging Study. Ann Epidemiol 2016; 26:163-70. [PMID: 26872919 PMCID: PMC4863452 DOI: 10.1016/j.annepidem.2015.12.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 12/15/2015] [Accepted: 12/24/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE The purpose of the study was to examine the prevalence and determinants of prediabetes, undiagnosed diabetes, and diabetes among Mexican adults from a subsample of the Mexican Health and Aging Study. METHODS We examined 2012 participants from a subsample of the Mexican Health and Aging Study. Measures included sociodemographic characteristics, body mass index, central obesity, medical conditions, cholesterol, high-density lipoprotein cholesterol, hemoglobin A1c, and vitamin D. Logistic regression was performed to identify factors associated with prediabetes, undiagnosed diabetes, and self-reported diabetes. RESULTS Prevalence of prediabetes, undiagnosed, and self-reported diabetes in this cohort was 44.2%, 18.0%, and 21.4%, respectively. Participants with high waist-hip ratio (1.61, 95% confidence interval [CI] = 1.05-2.45) and high cholesterol (1.85, 95% CI = 1.36-2.51) had higher odds of prediabetes. Overweight (1.68, 95% CI = 1.07-2.64), obesity (2.38, 95% CI = 1.41-4.02), and high waist circumference (1.60, 95% CI = 1.06-2.40) were significantly associated with higher odds of having undiagnosed diabetes. Those residing in a Mexican state with high U.S. migration had lower odds of prediabetes (0.61, 95% CI = 0.45-0.82) and undiagnosed diabetes (0.53, 95% CI = 0.41-0.70). Those engaged in regular physical activity had lower odds of undiagnosed diabetes (0.74, 95% CI = 0.57-0.97). CONCLUSIONS There is a high prevalence of prediabetes and undiagnosed diabetes among Mexican adults in this subsample. Findings suggest the need for resources to prevent, identify, and treat persons with prediabetes and undiagnosed diabetes.
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Affiliation(s)
- Amit Kumar
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston; Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston.
| | - Rebeca Wong
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston; Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston; Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston; Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | - Soham Al Snih
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston; Sealy Center on Aging, University of Texas Medical Branch, Galveston; Division of Geriatrics, Department of Internal Medicine, University of Texas Medical Branch, Galveston
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Lavalle-González FJ, Chiquete E. Patients' empowerment, physicians' perceptions, and achievement of therapeutic goals in patients with type 1 and type 2 diabetes mellitus in Mexico. Patient Prefer Adherence 2016; 10:1349-57. [PMID: 27555751 PMCID: PMC4968990 DOI: 10.2147/ppa.s107437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Physicians' perception may not parallel objective measures of therapeutic targets in patients with diabetes. This is an issue rarely addressed in the medical literature. We aimed to analyze physicians' perception and characteristics of adequate control of patients with diabetes. PATIENTS AND METHODS We studied information on physicians and their patients who participated in the third wave of the International Diabetes Management Practices Study registry in Mexico. This analysis was performed on 2,642 patients, 203 with type 1 diabetes mellitus (T1DM) and 2,439 with type 2 diabetes mellitus (T2DM), treated by 200 physicians. RESULTS The patients perceived at target had lower hemoglobin A1c (HbA1c) and fasting blood glucose than those considered not at target. However, overestimation of the frequency of patients with HbA1c <7% was 41.5% in patients with T1DM and 31.7% in patients with T2DM (underestimation: 2.8% and 8.0%, respectively). The agreement between the physicians' perception and the class of HbA1c was suboptimal (κ: 0.612). Diabetologists and endocrinologists tested HbA1c more frequently than primary care practitioners, internists, or cardiologists; however, no differences were observed in mean HbA1c, for both T1DM (8.4% vs 7.2%, P=0.42) and T2DM (8.03% vs 8.01%, P=0.87) patients. Nevertheless, insulin users perceived at target, who practiced self-monitoring and self-adjustment of insulin, had a lower mean HbA1c than patients without these characteristics (mean HbA1c in T1DM: 6.8% vs 9.6%, respectively; mean HbA1c in T2DM: 7.0% vs 10.1%, respectively). CONCLUSION Although there is a significant physicians' overestimation about the optimal glycemic control, this global impression and characteristics of patients' empowerment, such as self-monitoring and self-adjustment of insulin, are associated with the achievement of targets.
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Affiliation(s)
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Correspondence: Erwin Chiquete, Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlapan, Ciudad de México, Código Postal 14000, México, Tel +52 54 87 0900 ext 5052, Fax +52 56 55 1076, Email
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Rivera-Hernandez M, Galarraga O. Type of Insurance and Use of Preventive Health Services Among Older Adults in Mexico. J Aging Health 2015; 27:962-82. [PMID: 25804897 PMCID: PMC4720256 DOI: 10.1177/0898264315569457] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The main purpose of this article was to assess the differences between Seguro Popular (SP) and employer-based health insurance in the use of preventive services, including screening tests for diabetes, cholesterol, hypertension, cervical cancer, and prostate cancer among older adults at more than a decade of health care reform in Mexico. METHOD Logistic regression models were used with data from the Mexican Health and Nutrition Survey, 2012. RESULTS After adjusting for other factors influencing preventive service utilization, SP enrollees were more likely to use screening tests for diabetes, cholesterol, hypertension, and cervical cancer than the uninsured; however, those in employment-based and private insurances had higher odds of using preventive care for most of these services, except Pap smears. DISCUSSION Despite all the evidence that suggests that SP has increased access to health insurance for the poor, inequalities in health care access and utilization still exist in Mexico.
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Affiliation(s)
| | - Omar Galarraga
- Department of Health Services, Policy and Practice Brown University, Providence, RI, USA
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Sood N, Bendavid E, Mukherji A, Wagner Z, Nagpal S, Mullen P. Government health insurance for people below poverty line in India: quasi-experimental evaluation of insurance and health outcomes. BMJ 2014; 349:g5114. [PMID: 25214509 PMCID: PMC4161676 DOI: 10.1136/bmj.g5114] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate the effects of a government insurance program covering tertiary care for people below the poverty line in Karnataka, India, on out-of-pocket expenditures, hospital use, and mortality. DESIGN Geographic regression discontinuity study. SETTING 572 villages in Karnataka, India. PARTICIPANTS 31,476 households (22,796 below poverty line and 8680 above poverty line) in 300 villages where the scheme was implemented and 28,633 households (21,767 below poverty line and 6866 above poverty line) in 272 neighboring matched villages ineligible for the scheme. INTERVENTION A government insurance program (Vajpayee Arogyashree scheme) that provided free tertiary care to households below the poverty line in about half of villages in Karnataka from February 2010 to August 2012. MAIN OUTCOME MEASURE Out-of-pocket expenditures, hospital use, and mortality. RESULTS Among households below the poverty line, the mortality rate from conditions potentially responsive to services covered by the scheme (mostly cardiac conditions and cancer) was 0.32% in households eligible for the scheme compared with 0.90% among ineligible households just south of the eligibility border (difference of 0.58 percentage points, 95% confidence interval 0.40 to 0.75; P<0.001). We found no difference in mortality rates for households above the poverty line (households above the poverty line were not eligible for the scheme), with a mortality rate from conditions covered by the scheme of 0.56% in eligible villages compared with 0.55% in ineligible villages (difference of 0.01 percentage points, -0.03 to 0.03; P=0.95). Eligible households had significantly reduced out-of-pocket health expenditures for admissions to hospitals with tertiary care facilities likely to be covered by the scheme (64% reduction, 35% to 97%; P<0.001). There was no significant increase in use of covered services, although the point estimate of a 44.2% increase approached significance (-5.1% to 90.5%; P=0.059). Both reductions in out-of-pocket expenditures and potential increases in use might have contributed to the observed reductions in mortality. CONCLUSIONS Insuring poor households for efficacious but costly and underused health services significantly improves population health in India.
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Affiliation(s)
- Neeraj Sood
- Department of Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, CA, USA Leonard D Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA National Bureau of Economic Research, Cambridge, MA, USA
| | - Eran Bendavid
- Division of General Medical Disciplines, Stanford University, Stanford, CA, USA Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Arnab Mukherji
- Center for Public Policy, Indian Institute of Management Bangalore, Bangalore, India
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Abstract
BACKGROUND AND OBJECTIVES Frequent visits to diabetes care clinics linked with better control of diabetes mellitus (DM), but debates exist about how frequently visits should be done. The objective of this study was to assess the effect of frequent visits on diabetes care and control. DESIGN AND SETTINGS A prospective study of 100 diabetic patients attending Prince Abdul-Aziz Bin-Majed Diabetes Care Centre (PAMDCC), Al Madinah Al Munawwarah, Saudi Arabia, during the period from March 2011 through December 2012. METHODS Demographics, lifestyle, and diabetes data were obtained at the index visit. At that and subsequent visits, glycosated hemoglobin (HBA1c), blood pressure (BP) and low-density lipoprotein (LDL) were measured. All these data together with visit number and gap were recorded. Statistical analysis including linear regression analysis was done. RESULTS A significant reduction in the mean of diabetic control parameters was observed at the last visit. The highest mean changes were observed in patients with > 6 visits, visit gap =8. Adjusted linear regression showed that each visit significantly lowered HBA1c by 0.25%, BP by 2.1/0.7 mm Hg and 0.2 mmol/L for LDL. The number of visits needed to get HBA1c < 7% and BP < 130/85 was 8 and 5 visits with a visit-month index of 14 and 5, respectively. CONCLUSION The study suggests that frequent visits at short intervals may lead to better diabetes control. Other prospective clinical trial studies are needed to confirm these findings and to outline the appropriate cost-effective intervals and visit gaps.
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Affiliation(s)
- Omar Mansour Al
- Dr. Omar Mansour Al Nozha, Taibah University - Internal Medicine,, PO Box 30088 Madinah 41477, Madinah 41477, Saudi Arabia, T: 0555344992, F: 0148484800,
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Mudaliar U, Kim WC, Kirk K, Rouse C, Narayan KMV, Ali M. Are recommended standards for diabetes care met in Central and South America? A systematic review. Diabetes Res Clin Pract 2013; 100:306-29. [PMID: 23375230 DOI: 10.1016/j.diabres.2013.01.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 12/30/2012] [Accepted: 01/07/2013] [Indexed: 11/28/2022]
Abstract
AIMS We evaluated quality of diabetes care in low- and middle-income countries (LMIC) of Central and South America by documenting the ability to meet the guideline-recommended targets. We also identified barriers to achieving goals of treatment and characteristics of successful programs. METHODS We searched the National Library of Medicine and Embase databases to systematically compile literature that reported on guideline-recommended processes of care (annual foot, eye, urine examinations, and regular blood glucose testing) and risk factor control (glycemic, blood pressure, and lipid levels) among people with diabetes since 1980. We compared risk factor control across clinic and household populations and benchmarked against the IDF guidelines. RESULTS The available literature was largely from Mexico, Jamaica, and Brazil with little data from rural regions or smaller countries. Twenty-nine clinic-based and ten population-based studies showed a consistent failure to meet recommended care goals due to multiple underlying social and economic themes. Across all studies, the proportion of those not meeting targets ranged from 13.0 to 92.2% for glycemic control, 4.6 to 92.0% for blood pressure, and 28.2 to 78.3% for lipids. CONCLUSIONS Few studies report quality of diabetes care in LMICs of the Americas, and heterogeneity across studies limits our understanding. Greater regard for audits, use of standardized reporting methods, and an emphasis on overcoming barriers to care are required.
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Affiliation(s)
- Uma Mudaliar
- School of Medicine, Emory University, Atlanta, GA, USA.
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Barquera S, Campos-Nonato I, Aguilar-Salinas C, Lopez-Ridaura R, Arredondo A, Rivera-Dommarco J. Diabetes in Mexico: cost and management of diabetes and its complications and challenges for health policy. Global Health 2013; 9:3. [PMID: 23374611 PMCID: PMC3599194 DOI: 10.1186/1744-8603-9-3] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 01/25/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Mexico has been experiencing some of the most rapid shifts ever recorded in dietary and physical activity patterns leading to obesity. Diabetes mellitus has played a crucial role causing nearly 14% of all deaths. We wanted to make a comprehensive study of the role of diabetes in terms of burden of disease, prevalence, cost of diabetes, cost of complications and health policy. METHOD We review the quantitative data that provides evidence of the extent to which the Mexican health economy is affected by the disease and its complications. We then discuss the current situation of diabetes in Mexico with experts in the field. RESULTS There was a significant increase in the prevalence of diabetes from 1994 to 2006 with rising direct costs (2006: outpatient USD$ 717,764,787, inpatient USD$ 223,581,099) and indirect costs (2005: USD$ 177,220,390), and rising costs of complications (2010: Retinopathy USD$ 10,323,421; Cardiovascular disease USD$ 12,843,134; Nephropathy USD$ 81,814,501; Neuropathy USD$ 2,760,271; Peripheral vascular disease USD$ 2,042,601). The health policy focused on screening and the creation of self-support groups across the country. CONCLUSIONS The increasing diabetes mortality and lack of control among diagnosed patients make quality of treatment a major concern in Mexico. The growing prevalence of childhood and adult obesity and the metabolic syndrome suggest that the situation could be even worse in the coming years. The government has reacted strongly with national actions to address the growing burden posed by diabetes. However our research suggests that the prevalence and mortality of diabetes will continue to rise in the future.
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Affiliation(s)
- Simon Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655. Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Mor, CP. 62508, Mexico, Mexico
| | - Ismael Campos-Nonato
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655. Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Mor, CP. 62508, Mexico, Mexico
| | - Carlos Aguilar-Salinas
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F, Mexico
| | - Ruy Lopez-Ridaura
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655. Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Mor, CP. 62508, Mexico, Mexico
| | - Armando Arredondo
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655. Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Mor, CP. 62508, Mexico, Mexico
| | - Juan Rivera-Dommarco
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Av. Universidad No. 655. Col. Sta. Ma. Ahuacatitlán, Cuernavaca, Mor, CP. 62508, Mexico, Mexico
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Al-Lawati JA, Barakat MN, Al-Maskari M, Elsayed MK, Al-Lawati AM, Mohammed AJ. HbA1c Levels among Primary Healthcare Patients with Type 2 Diabetes Mellitus in Oman. Oman Med J 2012; 27:465-70. [PMID: 23226816 DOI: 10.5001/omj.2012.111] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 09/03/2012] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate whether younger patients with type 2 diabetes mellitus have higher glycated hemoglobin A1c (HbA1c) levels compared to older patients, and to determine the factors associated with higher HbA1c levels. METHODS Data from 1,266 patients from all over Oman were used to obtain the mean HbA1c level, odds ratios (OR), and 95% confidence intervals (CI) from multiple logistic regression models with age groups, sex, duration of diabetes, diabetes treatment, body mass index, estimated glomerular filtration rate (eGFR), tobacco use, and healthcare index as predictors of good (HbA1c <7%) vs. poor (≥7%) glycemic control. RESULTS Mean HbA1c levels were 8.9, 8.3, and 7.8 in the age groups 20-39, 40-59 and 60+ years, respectively. After controlling for all other covariates, the OR of good glycemic control increased with age, 40-59 years old (OR=1.7; 95% CI 1.1 to 2.6) and 60+ year (OR=2.5; 95% CI 1.6 to 4.0), female gender (OR=1.5; 95% CI 1.2 to 2.0) and in patients with eGFR ≥60 mL/min/1.73 m(2) (OR=1.9; 95% CI 1.1 to 3.3). Longer duration of diabetes (≥5 years) and treatment with oral agents or insulin were inversely related to good glycemic control. CONCLUSION Younger Omani adults exhibit worse glycemic levels compared to older adults posing a formidable challenge to diabetes care teams.
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Affiliation(s)
- Jawad A Al-Lawati
- Department of Non-communicable Diseases Surveillance and Control, Ministry of Health, Oman
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Lavalle-González FJ, Chiquete E, de la Luz J, Ochoa-Guzmán A, Sánchez-Orozco LV, Godínez-gutiérrez SA. Achievement of therapeutic targets in Mexican patients with diabetes mellitus. ACTA ACUST UNITED AC 2012; 59:591-8. [DOI: 10.1016/j.endonu.2012.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 06/25/2012] [Accepted: 07/03/2012] [Indexed: 11/26/2022]
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Knaul FM, González-Pier E, Gómez-Dantés O, García-Junco D, Arreola-Ornelas H, Barraza-Lloréns M, Sandoval R, Caballero F, Hernández-Avila M, Juan M, Kershenobich D, Nigenda G, Ruelas E, Sepúlveda J, Tapia R, Soberón G, Chertorivski S, Frenk J. The quest for universal health coverage: achieving social protection for all in Mexico. Lancet 2012; 380:1259-79. [PMID: 22901864 DOI: 10.1016/s0140-6736(12)61068-x] [Citation(s) in RCA: 275] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mexico is reaching universal health coverage in 2012. A national health insurance programme called Seguro Popular, introduced in 2003, is providing access to a package of comprehensive health services with financial protection for more than 50 million Mexicans previously excluded from insurance. Universal coverage in Mexico is synonymous with social protection of health. This report analyses the road to universal coverage along three dimensions of protection: against health risks, for patients through quality assurance of health care, and against the financial consequences of disease and injury. We present a conceptual discussion of the transition from labour-based social security to social protection of health, which implies access to effective health care as a universal right based on citizenship, the ethical basis of the Mexican reform. We discuss the conditions that prompted the reform, as well as its design and inception, and we describe the 9-year, evidence-driven implementation process, including updates and improvements to the original programme. The core of the report concentrates on the effects and impacts of the reform, based on analysis of all published and publically available scientific literature and new data. Evidence indicates that Seguro Popular is improving access to health services and reducing the prevalence of catastrophic and impoverishing health expenditures, especially for the poor. Recent studies also show improvement in effective coverage. This research then addresses persistent challenges, including the need to translate financial resources into more effective, equitable and responsive health services. A next generation of reforms will be required and these include systemic measures to complete the reorganisation of the health system by functions. The paper concludes with a discussion of the implications of the Mexican quest to achieve universal health coverage and its relevance for other low-income and middle-income countries.
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López-López E, Gutiérrez-Soria D, Idrovo AJ. Evaluation of a diabetes care program using the effective coverage framework. Int J Qual Health Care 2012; 24:619-25. [PMID: 23042797 DOI: 10.1093/intqhc/mzs056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To measure the effective coverage of a program to control type 2 diabetes. DESIGN Observational study combining multiple DATA SOURCES SETTING Hidalgo state, Mexico. PARTICIPANTS Adults without social security health benefits and patients with a diagnosis of diabetes participating in the program. MAIN OUTCOME MEASURES Detection of diabetes; glucose, cholesterol, triglyceride and blood pressure control; education; diabetic retinopathy, diabetic foot and nephropathy prevention. RESULTS Only 7.1% of individuals with diabetes participated in the control program. Fasting glucose and HbA1c values were available for 95.6 and 35.6 of patients, respectively. There were measurements of total cholesterol (52.1%), triglyceride (50.6%) and blood pressure (99.6%). Educative activities were realized for 64.8% of patients. The most important gaps were related with detection of illness, low-density lipoprotein cholesterol control, glucose control with HbA1c and nephropathy prevention. Effective coverage of these medical actions was 6.22, 5.07, 5.01 and 0.34%, respectively. CONCLUSIONS The greatest challenge to overcome is the detection of individuals with illness because a large number of individuals with type 2 diabetes do not use health services and the health system does not systematically search them out. Medical actions that require resources that must be paid for by patients tend to be used less and to be of lower quality. The use of effective coverage to measure the performance of diabetes care program provides practical information to improve health services.
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Affiliation(s)
- Erika López-López
- Coordination of Research, Ministry of Health, Pachuca, Hidalgo, Mexico
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Danese-dlSantos LG, Sosa-Rubí SG, Valencia-Mendoza A. Analysis of changes in the association of income and the utilization of curative health services in Mexico between 2000 and 2006. BMC Public Health 2011; 11:771. [PMID: 21978183 PMCID: PMC3203078 DOI: 10.1186/1471-2458-11-771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 10/07/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A common characteristic of health systems in most developing countries is unequal access to health services. As a result, members of the poorest population groups often do not receive formal attention for health services, because they cannot afford it. In 2001 in Mexico, to address income-related differences in the use of health services, the government launched a major healthcare reform, which includes a health insurance program called Seguro Popular, aimed at improving healthcare access among poor, uninsured residents. This paper analyzes the before and after changes in the demand for curative ambulatory health services focusing on the association of income-related characteristics and the utilization of formal healthcare providers vs. no healthcare service utilization. METHODS By using two nationally representative health surveys (ENSA-2000 and ENSANUT-2006), we modeled an individual's decision when experiencing an illness to use services provided by the (1) Ministry of Health (MoH), (2) social security, (3) private entities, or (4) to not use formal services (no healthcare service utilization). RESULTS Poorer individuals were more likely in 2006 than in 2000 to respond to an illness by using formal healthcare providers. Trends in provider selection differed, however. The probability of using public services from the MoH increased among the poorest population, while the findings indicated an increase in utilization of private health services among members of low- and middle-income groups. No significant change was seen among formal workers -covered by social security services-, regardless of socioeconomic status. CONCLUSIONS Overall, for 2006 the Mexican population appears less differentiated in using healthcare across economic groups than in 2000. This may be related, in part, to the implementation of Seguro Popular, which seems to be stimulating healthcare demand among the poorest and previously uninsured segment of the population. Still, public health authorities need to address the remaining income-related healthcare utilization differences, the differences in quality between public and private health services, and the general perception that MoH facilities offer inferior services.
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Affiliation(s)
- Laura G Danese-dlSantos
- Center for Evaluation Research and Surveys, Division of Health Economics, National Institute of Public Health (INSP), Av. Universidad 655, Cuernavaca 62508, Morelos, Mexico
| | - Sandra G Sosa-Rubí
- Center for Evaluation Research and Surveys, Division of Health Economics, National Institute of Public Health (INSP), Av. Universidad 655, Cuernavaca 62508, Morelos, Mexico
| | - Atanacio Valencia-Mendoza
- Center for Evaluation Research and Surveys, Division of Health Economics, National Institute of Public Health (INSP), Av. Universidad 655, Cuernavaca 62508, Morelos, Mexico
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