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Wirtz VJ, Servan-Mori E, Mungai J, Mboya J, Rockers PC, Onyango MA, Kiragu ZW, Laing R. Probability and amount of medicines expenditure according to health insurance status in Kenya: A household survey in eight counties. Int J Health Plann Manage 2021; 37:725-733. [PMID: 34674309 PMCID: PMC9298347 DOI: 10.1002/hpm.3368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 07/17/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background National and county governments in Kenya have introduced various health insurance schemes to protect households against financial hardship as a result of large health expenditure. This study examines the relationship between health insurance and medicine expenditure in eight counties in Kenya. Methods A cross‐sectional study of collected primary data via household survey in eight counties was performed. Three measures of medicine expenditure were analysed: the probability of any out‐of‐pocket expenditure (OOPE) on medicines in the last 4 weeks; amount of OOPE on medicines; and OOPE on medicines as a proportion of total OOPE on health. Results Out of the 452 individuals, those with health insurance (n = 225) were significantly different from individuals without health insurance (n = 227): overall, they were older, had a higher level of educational attainment and possessed more assets. Adjusting for covariates, individuals with health insurance had a reduced probability of OOPE on medicines (0.40, CI95% 0.197–0.827) and spent proportionally less on medicines out of total health expenditure (0.50, CI95% 0.301–0.926). Conclusions Kenya has made great strides to scale up Universal Health Coverage including access to medicines. Prioritising enrollment of low‐income individuals with non‐communicable diseases can accelerate access to medicines and financial protection.
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Affiliation(s)
- Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Edson Servan-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - John Mungai
- Innovation for Poverty Action, Nairobi, Kenya
| | - John Mboya
- Innovation for Poverty Action, Nairobi, Kenya
| | - Peter C Rockers
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Monica A Onyango
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Zana Wangari Kiragu
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Richard Laing
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.,School of Public Health, University of Western Cape, Cape Town, South Africa
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Sosa-Rubí SG, Contreras-Loya D, Pedraza-Arizmendi D, Chivardi-Moreno C, Alarid-Escudero F, López-Ridaura R, Servan-Mori E, Molina-Cuevas V, Casales-Hernández G, Espinosa-López C, González-Roldán JF, Silva-Tinoco R, Seiglie J, Gómez-Dantés O. Cost-effectiveness analysis of a multidisciplinary health-care model for patients with type-2 diabetes implemented in the public sector in Mexico: A quasi-experimental, retrospective evaluation. Diabetes Res Clin Pract 2020; 167:108336. [PMID: 32755762 PMCID: PMC8010712 DOI: 10.1016/j.diabres.2020.108336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/02/2020] [Accepted: 07/16/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In 2007, the Ministry of Health (MoH) in Mexico implemented a multidisciplinary health-care model (MHC) for patients with type-2 diabetes (T2D), which has proven more effective in controlling this condition than the conventional health-care model (CHC). RESEARCH DESIGN AND METHODS We compared the cost-effectiveness of the MHC vs. the CHC for patients with T2D using a quasi-experimental, retrospective design. Epidemiologic and cost data were obtained from a randomly selected sample of health-care units, using medical records as well as patient- and facility-level data. We modelled the cost-effectiveness of the MHC at one, 10 and 20 years using a simulation model. RESULTS The average cumulative costs per patient at 20 years were US$4,225 for the MHC and US$4,399 for the CHC. With a willingness to pay one gross domestic product (GDP) per capita per quality-adjusted life year (QALY) (US$8,910), the incremental net benefits per patient were US$1,450 and US$3,737 at 10 and 20 years, respectively. The MHC was cost-effective from the third year onward; however, increasing coverage to 500 patients per year rendered it cost-effective at year one. CONCLUSIONS The MHC is cost-effective at 10 and 20 years. Cost-effectiveness can be achieved in the short term by increasing MHC coverage.
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Affiliation(s)
- S G Sosa-Rubí
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP).
| | | | - D Pedraza-Arizmendi
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP)
| | - C Chivardi-Moreno
- Division of Health Economics and Health Systems Innovations, National Institute of Public Health (INSP)
| | - F Alarid-Escudero
- Division of Public Administration, Center for Research and Teaching in Economics, Aguascalientes, Mexico
| | - R López-Ridaura
- National Center for Disease Prevention and Control Programs (CENAPRECE), Ministry of Health, Mexico
| | - E Servan-Mori
- Health System Research Center, National Institute of Public Health (INSP)
| | - V Molina-Cuevas
- Pan American Health Organization, Mexico City Office, Mexico
| | - G Casales-Hernández
- National Center for Disease Prevention and Control Programs (CENAPRECE), Ministry of Health, Mexico
| | | | | | - R Silva-Tinoco
- Specialized Clinic in Diabetes Management, Mexico City-Iztapalapa, Ministry of Health/ Ministry of Health in Mexico City
| | - J Seiglie
- Diabetes Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA
| | - O Gómez-Dantés
- Health System Research Center, National Institute of Public Health (INSP)
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Heredia-Pi I, Servan-Mori E, Darney BG, Reyes-Morales H, Lozano R. Measuring the adequacy of antenatal health care: a national cross-sectional study in Mexico. Bull World Health Organ 2018; 94:452-61. [PMID: 27274597 PMCID: PMC4890208 DOI: 10.2471/blt.15.168302] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To propose an antenatal care classification for measuring the continuum of health care based on the concept of adequacy: timeliness of entry into antenatal care, number of antenatal care visits and key processes of care. METHODS In a cross-sectional, retrospective study we used data from the Mexican National Health and Nutrition Survey (ENSANUT) in 2012. This contained self-reported information about antenatal care use by 6494 women during their last pregnancy ending in live birth. Antenatal care was considered to be adequate if a woman attended her first visit during the first trimester of pregnancy, made a minimum of four antenatal care visits and underwent at least seven of the eight recommended procedures during visits. We used multivariate ordinal logistic regression to identify correlates of adequate antenatal care and predicted coverage. FINDINGS Based on a population-weighted sample of 9 052 044, 98.4% of women received antenatal care during their last pregnancy, but only 71.5% (95% confidence interval, CI: 69.7 to 73.2) received maternal health care classified as adequate. Significant geographic differences in coverage of care were identified among states. The probability of receiving adequate antenatal care was higher among women of higher socioeconomic status, with more years of schooling and with health insurance. CONCLUSION While basic antenatal care coverage is high in Mexico, adequate care remains low. Efforts by health systems, governments and researchers to measure and improve antenatal care should adopt a more rigorous definition of care to include important elements of quality such as continuity and processes of care.
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Affiliation(s)
- Ileana Heredia-Pi
- Center for Health System Research, National Institute of Public Health, Av. Universidad #655, 62100, Cuernavaca, Morelos, Mexico
| | - Edson Servan-Mori
- Center for Health System Research, National Institute of Public Health, Av. Universidad #655, 62100, Cuernavaca, Morelos, Mexico
| | - Blair G Darney
- Center for Health System Research, National Institute of Public Health, Av. Universidad #655, 62100, Cuernavaca, Morelos, Mexico
| | | | - Rafael Lozano
- Center for Health System Research, National Institute of Public Health, Av. Universidad #655, 62100, Cuernavaca, Morelos, Mexico
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Silverman-Retana O, Servan-Mori E, Bertozzi SM, Orozco-Nuñez E, Bautista-Arredondo S, Lopez-Ridaura R. Prison environment and non-communicable chronic disease modifiable risk factors: length of incarceration trend analysis in Mexico City. J Epidemiol Community Health 2018; 72:342-348. [PMID: 29367281 DOI: 10.1136/jech-2017-209843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/17/2017] [Accepted: 12/29/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is a lack of evidence regarding chronic disease modifiable risk factors among prisoner populations in Latin America. The purpose of this study was to estimate the prevalence of modifiable risk factors for chronic diseases and to assess their relationship with length of incarceration. METHODS We analysed data from a cross sectional study in which 4241 prisoners were randomly selected to answer a questionnaire with socio-demographic and health behaviour content using an audio computer-assisted self-interview format. Physical activity (PA), low-quality diet, current smoking and alcohol or cocaine use during the last month in prison were our main outcomes. Quantile regression models and logistic regression models were performed. RESULTS Our final analytical sample consisted of 3774 prisoners from four Mexico City prisons. PA was estimated as 579 median metabolic equivalents-min/week, prevalence of alcohol use was 23.4%, cocaine use was 24.2% and current smoking was 53.2%. Our results suggest that, as length of incarceration increased, PA as well as alcohol and cocaine use increased, whereas the quality of diet decreased. CONCLUSION This study supports the hypothesis that exposure to prison environment (measured by length of incarceration) fosters modifiable risk factors for chronic diseases, particularly diet quality and cocaine use.
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Affiliation(s)
- Omar Silverman-Retana
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Edson Servan-Mori
- Centre for Health Systems Research, National Institute of Public Health Mexico, Cuernavaca, Mexico
| | | | - Emanuel Orozco-Nuñez
- Centre for Health Systems Research, National Institute of Public Health Mexico, Cuernavaca, Mexico
| | | | - Ruy Lopez-Ridaura
- Centre for Population Health Research, National Institute of Public Health Mexico, Mexico City, Mexico
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5
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Leyva-Flores R, Infante C, Servan-Mori E, Quintino-Pérez F, Silverman-Retana O. HIV Prevalence Among Central American Migrants in Transit Through Mexico to the USA, 2009-2013. J Immigr Minor Health 2018; 18:1482-1488. [PMID: 26359004 DOI: 10.1007/s10903-015-0268-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
HIV prevalence was estimated among migrants in transit through Mexico. Data were collected on 9108 Central American migrants during a cross-sectional study performed in seven migrant shelters from 2009 to 2013. Considerations focused on their sociodemographic characteristics, sexual and reproductive health, and experience with violence. Based on a sample of 46.6 % of respondents who agreed to be HIV tested, prevalence of the virus among migrants came to 0.71 %, reflecting the concentrated epidemic in their countries of origin. A descriptive analysis was performed according to gender: the distribution of the epidemic peaked at 3.45 % in the transvestite, transgender and transsexual (TTT) population, but fell to less than 1 % in men and women. This gender differential is characteristic of the epidemic in Central America. Furthermore, 23.5 % of TTTs and 5.8 % of women experienced sexual violence. The predominant impact of sexual violence on TTTs and women will influence the course of the AIDS epidemic.
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Affiliation(s)
- René Leyva-Flores
- Centre for Health Systems Research, National Institute of Public Health, Mexico, Mexico
| | - César Infante
- Centre for Health Systems Research, National Institute of Public Health, Mexico, Mexico. .,Instituto Nacional de Salud Pública, México. Av. Universidad 655, C.P. 62100, Cuernavaca, Morelos, Mexico.
| | - Edson Servan-Mori
- Centre for Health Systems Research, National Institute of Public Health, Mexico, Mexico
| | | | - Omar Silverman-Retana
- Centre for Health Systems Research, National Institute of Public Health, Mexico, Mexico
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Gómez-Dantés H, Fullman N, Lamadrid-Figueroa H, Cahuana-Hurtado L, Darney B, Avila-Burgos L, Correa-Rotter R, Rivera JA, Barquera S, González-Pier E, Aburto-Soto T, de Castro EFA, Barrientos-Gutiérrez T, Basto-Abreu AC, Batis C, Borges G, Campos-Nonato I, Campuzano-Rincón JC, de Jesús Cantoral-Preciado A, Contreras-Manzano AG, Cuevas-Nasu L, de la Cruz-Gongora VV, Diaz-Ortega JL, de Lourdes García-García M, Garcia-Guerra A, de Cossío TG, González-Castell LD, Heredia-Pi I, Hijar-Medina MC, Jauregui A, Jimenez-Corona A, Lopez-Olmedo N, Magis-Rodríguez C, Medina-Garcia C, Medina-Mora ME, Mejia-Rodriguez F, Montañez JC, Montero P, Montoya A, Moreno-Banda GL, Pedroza-Tobías A, Pérez-Padilla R, Quezada AD, Richardson-López-Collada VL, Riojas-Rodríguez H, Ríos Blancas MJ, Razo-Garcia C, Mendoza MPR, Sánchez-Pimienta TG, Sánchez-Romero LM, Schilmann A, Servan-Mori E, Shamah-Levy T, Téllez-Rojo MM, Texcalac-Sangrador JL, Wang H, Vos T, Forouzanfar MH, Naghavi M, Lopez AD, Murray CJL, Lozano R. Dissonant health transition in the states of Mexico, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2016; 388:2386-2402. [PMID: 27720260 DOI: 10.1016/s0140-6736(16)31773-1] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 08/15/2016] [Accepted: 08/22/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Child and maternal health outcomes have notably improved in Mexico since 1990, whereas rising adult mortality rates defy traditional epidemiological transition models in which decreased death rates occur across all ages. These trends suggest Mexico is experiencing a more complex, dissonant health transition than historically observed. Enduring inequalities between states further emphasise the need for more detailed health assessments over time. The Global Burden of Diseases, Injuries, and Risk Factors Study 2013 (GBD 2013) provides the comprehensive, comparable framework through which such national and subnational analyses can occur. This study offers a state-level quantification of disease burden and risk factor attribution in Mexico for the first time. METHODS We extracted data from GBD 2013 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) in Mexico and its 32 states, along with eight comparator countries in the Americas. States were grouped by Marginalisation Index scores to compare subnational burden along a socioeconomic dimension. We split extracted data by state and applied GBD methods to generate estimates of burden, and attributable burden due to behavioural, metabolic, and environmental or occupational risks. We present results for 306 causes, 2337 sequelae, and 79 risk factors. FINDINGS From 1990 to 2013, life expectancy from birth in Mexico increased by 3·4 years (95% uncertainty interval 3·1-3·8), from 72·1 years (71·8-72·3) to 75·5 years (75·3-75·7), and these gains were more pronounced in states with high marginalisation. Nationally, age-standardised death rates fell 13·3% (11·9-14·6%) since 1990, but state-level reductions for all-cause mortality varied and gaps between life expectancy and years lived in full health, as measured by HALE, widened in several states. Progress in women's life expectancy exceeded that of men, in whom negligible improvements were observed since 2000. For many states, this trend corresponded with rising YLL rates from interpersonal violence and chronic kidney disease. Nationally, age-standardised YLL rates for diarrhoeal diseases and protein-energy malnutrition markedly decreased, ranking Mexico well above comparator countries. However, amid Mexico's progress against communicable diseases, chronic kidney disease burden rapidly climbed, with age-standardised YLL and DALY rates increasing more than 130% by 2013. For women, DALY rates from breast cancer also increased since 1990, rising 12·1% (4·6-23·1%). In 2013, the leading five causes of DALYs were diabetes, ischaemic heart disease, chronic kidney disease, low back and neck pain, and depressive disorders; the latter three were not among the leading five causes in 1990, further underscoring Mexico's rapid epidemiological transition. Leading risk factors for disease burden in 1990, such as undernutrition, were replaced by high fasting plasma glucose and high body-mass index by 2013. Attributable burden due to dietary risks also increased, accounting for more than 10% of DALYs in 2013. INTERPRETATION Mexico achieved sizeable reductions in burden due to several causes, such as diarrhoeal diseases, and risks factors, such as undernutrition and poor sanitation, which were mainly associated with maternal and child health interventions. Yet rising adult mortality rates from chronic kidney disease, diabetes, cirrhosis, and, since 2000, interpersonal violence drove deteriorating health outcomes, particularly in men. Although state inequalities from communicable diseases narrowed over time, non-communicable diseases and injury burdens varied markedly at local levels. The dissonance with which Mexico and its 32 states are experiencing epidemiological transitions might strain health-system responsiveness and performance, which stresses the importance of timely, evidence-informed health policies and programmes linked to the health needs of each state. FUNDING Bill & Melinda Gates Foundation, Instituto Nacional de Salud Pública.
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Affiliation(s)
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | - Blair Darney
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | - Ricardo Correa-Rotter
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan A Rivera
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | | | | | | | | | | | | | - Guilherme Borges
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Maria E Medina-Mora
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | | | - Pablo Montero
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alan D Lopez
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Rafael Lozano
- Instituto Nacional de Salud Pública, Cuernavaca, Mexico; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
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Silverman-Retana O, Servan-Mori E, Lopez-Ridaura R, Bautista-Arredondo S. Diabetes and hypertension care among male prisoners in Mexico City: exploring transition of care and the equivalence principle. Int J Public Health 2016; 61:651-659. [PMID: 27094508 DOI: 10.1007/s00038-016-0812-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To document the performance of diabetes and hypertension care in two large male prisons in Mexico City. METHODS We analyzed data from a cross-sectional study carried out during July-September 2010, including 496 prisoners with hypertension or diabetes in Mexico City. Bivariate and multivariable logistic regressions were used to assess process-of-care indicators and disease control status. RESULTS Hypertension and diabetes prevalence were estimated on 2.1 and 1.4 %, respectively. Among prisoners with diabetes 22.7 % (n = 62) had hypertension as comorbidity. Low achievement of process-of-care indicators-follow-up visits, blood pressure and laboratory assessments-were observed during incarceration compared to the same prisoners in the year prior to incarceration. In contrast to nonimprisoned diabetes population from Mexico City and from the lowest quintile of socioeconomic status at the national level, prisoners with diabetes had the lowest performance on process-of-care indicators. CONCLUSIONS Continuity of care for chronic diseases, coupled with the equivalence of care principle, should provide the basis for designing chronic disease health policy for prisoners, with the goal of consistent transition of care from community to prison and vice versa.
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Affiliation(s)
- Omar Silverman-Retana
- Centre for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Edson Servan-Mori
- Centre for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico.
| | - Ruy Lopez-Ridaura
- Centre for Population Health Research, National Institute of Public Health, Mexico City, Mexico
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Servan-Mori E, Avila-Burgos L, Nigenda G, Lozano R. A Performance Analysis of Public Expenditure on Maternal Health in Mexico. PLoS One 2016; 11:e0152635. [PMID: 27043819 PMCID: PMC4820121 DOI: 10.1371/journal.pone.0152635] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/16/2016] [Indexed: 11/19/2022] Open
Abstract
We explore the relationship between public expenditure, coverage of adequate ANC (including timing, frequent and content), and the maternal mortality ratio--adjusted by coverage of adequate ANC--observed in Mexico in 2012 at the State level. Additionally, we examine the inequalities and concentration of public expenditure between populations with and without Social Security. Results suggest that in the 2003-2011 period, the public expenditure gap between women with and without Social Security decreased 74%, however, the distribution is less equitable among women without Social Security, across the States. Despite high levels of coverage on each dimension of ANC explored, coverage of adequate ANC was lower among Social Security than non-Social Security women. This variability results in differences up to 1.5 times in State-adjusted maternal mortality rate at the same level of expense and maternal mortality rate, respectively. The increase in the economic resources is only a necessary condition for achieving improved health outcomes. Providing adequate health services and achieving efficient, effective and transparent use of resources in health, are critical elements for health systems performance. The attainment of universal effective coverage of maternal health and reducing maternal mortality in Mexico, requires the adjustment of policy innovations including the rules of allocation and execution of health resources. Health policies should be designed on a more holistic view promoting a balance between accessibility, effective implementation and rigorous stewardship.
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Affiliation(s)
| | | | - Gustavo Nigenda
- School of Medicine, State of Morelos Autonomous University, Cuernavaca, Morelos, Mexico
| | - Rafael Lozano
- National Institute of Public Health, Cuernavaca, Morelos, Mexico
- Institute for Health Metrics and Evaluation, UW, Seattle, WA, United States of America
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9
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Darney BG, Sosa-Rubi SG, Servan-Mori E, Rodriguez MI, Walker D, Lozano R. The relationship of age and place of delivery with postpartum contraception prior to discharge in Mexico: A retrospective cohort study. Contraception 2016; 93:478-84. [PMID: 26828625 PMCID: PMC4863522 DOI: 10.1016/j.contraception.2016.01.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 01/25/2016] [Accepted: 01/26/2016] [Indexed: 11/28/2022]
Abstract
Objectives To test the association of age (adolescents vs. older women) and place of delivery with receipt of immediate postpartum contraception in Mexico. Study design Retrospective cohort study, Mexico, nationally representative sample of women 12–39 years old at last delivery. We used multivariable logistic regression to test the association of self-reported receipt of postpartum contraception prior to discharge with age and place of delivery (public, employment based, private, or out of facility). We included individual and household-level confounders and calculated relative and absolute multivariable estimates of association. Results Our analytic sample included 7022 women (population, N = 9,881,470). Twenty percent of the population was 12–19 years old at last birth, 55% aged 20–29 and 25% 30–39 years old. Overall, 43% of women reported no postpartum contraceptive method. Age was not significantly associated with receipt of a method, controlling for covariates. Women delivering in public facilities had lower odds of receipt of a method (Odds Ratio = 0.52; 95% Confidence Interval (CI) = 0.40–0.68) compared with employment-based insurance facilities. We estimated 76% (95% CI = 74–78%) of adolescents (12–19 years) who deliver in employment-based insurance facilities leave with a method compared with 59% (95% CI = 56–62%) who deliver in public facilities. Conclusion Both adolescents and women ages 20–39 receive postpartum contraception, but nearly half of all women receive no method. Place of delivery is correlated with receipt of postpartum contraception, with lower rates in the public sector. Lessons learned from Mexico are relevant to other countries seeking to improve adolescent health through reducing unintended pregnancy. Implications Adolescents receive postpartum contraception as often as older women in Mexico, but half of all women receive no method.
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Affiliation(s)
- Blair G Darney
- Center for Health Systems Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico; Oregon Health & Science University, Department of Obstetrics & Gynecology, Portland, OR.
| | - Sandra G Sosa-Rubi
- Center for Health Systems Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Edson Servan-Mori
- Center for Health Systems Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Maria I Rodriguez
- Oregon Health & Science University, Department of Obstetrics & Gynecology, Portland, OR; World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland
| | - Dilys Walker
- University of California, San Francisco, San Francisco, CA
| | - Rafael Lozano
- Center for Health Systems Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA
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Avila-Burgos L, Cahuana-Hurtado L, Montañez-Hernandez J, Servan-Mori E, Aracena-Genao B, del Río-Zolezzi A. Financing Maternal Health and Family Planning: Are We on the Right Track? Evidence from the Reproductive Health Subaccounts in Mexico, 2003-2012. PLoS One 2016; 11:e0147923. [PMID: 26812646 PMCID: PMC4728114 DOI: 10.1371/journal.pone.0147923] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 01/11/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To analyze whether the changes observed in the level and distribution of resources for maternal health and family planning (MHFP) programs from 2003 to 2012 were consistent with the financial goals of the related policies. MATERIALS AND METHODS A longitudinal descriptive analysis of the Mexican Reproductive Health Subaccounts 2003-2012 was performed by financing scheme and health function. Financing schemes included social security, government schemes, household out-of-pocket (OOP) payments, and private insurance plans. Functions were preventive care, including family planning, antenatal and puerperium health services, normal and cesarean deliveries, and treatment of complications. Changes in the financial imbalance indicators covered by MHFP policy were tracked: (a) public and OOP expenditures as percentages of total MHFP spending; (b) public expenditure per woman of reproductive age (WoRA, 15-49 years) by financing scheme; (c) public expenditure on treating complications as a percentage of preventive care; and (d) public expenditure on WoRA at state level. Statistical analyses of trends and distributions were performed. RESULTS Public expenditure on government schemes grew by approximately 300%, and the financial imbalance between populations covered by social security and government schemes decreased. The financial burden on households declined, particularly among households without social security. Expenditure on preventive care grew by 16%, narrowing the financing gap between treatment of complications and preventive care. Finally, public expenditure per WoRA for government schemes nearly doubled at the state level, although considerable disparities persist. CONCLUSIONS Changes in the level and distribution of MHFP funding from 2003 to 2012 were consistent with the relevant policy goals. However, improving efficiency requires further analysis to ascertain the impact of investments on health outcomes. This, in turn, will require better financial data systems as a precondition for improving the monitoring and accountability functions in Mexico.
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Affiliation(s)
- Leticia Avila-Burgos
- Center for Health Systems Research, National Institute of Public Health, Morelos, Mexico
| | - Lucero Cahuana-Hurtado
- Center for Health Systems Research, National Institute of Public Health, Morelos, Mexico
| | | | - Edson Servan-Mori
- Center for Health Systems Research, National Institute of Public Health, Morelos, Mexico
| | - Belkis Aracena-Genao
- Research Center for Evaluation and Surveys, National Institute of Public Health, Morelos, Mexico
| | - Aurora del Río-Zolezzi
- National Center for Gender Equity and Reproductive Health, Ministry of Health, Mexico City, Mexico
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Bautista-Arredondo S, Servan-Mori E, Beynon F, González A, Volkow P. A tale of two epidemics: gender differences in socio-demographic characteristics and sexual behaviors among HIV positive individuals in Mexico City. Int J Equity Health 2015; 14:147. [PMID: 26671333 PMCID: PMC4681055 DOI: 10.1186/s12939-015-0286-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 12/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To date, the HIV epidemic in Mexico has been concentrated mainly among men who have sex with men, butheterosexual transmission, particularly to women, is increasingly important. This study examine gender differences in socio-demographic characteristics and risk behaviors of HIV positive individuals in Mexico City. METHODS We analyzed data from a cross-sectional survey of 1,490 clinic patients (male:female ratio 8:1) with HIV inMexico City in 2010. We examined socio-demographic characteristics, risk behavior, and history of HIV infection.From multivariate non-linear probability (probit) models we calculated predicted probabilities by sex of several outcomes: marginalization, demographic and sexual risk behaviors. RESULTS Significant differences were found between men and women. Multivariate models suggest that women had lower schooling levels; were less likely to have been employed in the past month and earn more than the minimal wage; more likely to have children, to have been sexually abused, to never have used condoms and to report having been infected by a stable partner. Additionally, women were less likely to report having a partner with a history of migration to the USA and to have engaged in transactional sex. CONCLUSION Significant differences exist between men and women with HIV in Mexico City in terms of their socioeconomicand behavioral profiles, which translate into differences in terms of exposure to HIV infection. Women face social and economic vulnerability while men tend to have riskier sexual behavior. Gender issues must be approached in prevention and treatment efforts, using diverse methods to target those most vulnerable and at risk.
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Affiliation(s)
| | | | - Fenella Beynon
- National Institute of Public Health, Cuernavaca, Mexico.
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12
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Servan-Mori E, Heredia-Pi I, Montañez-Hernandez J, Avila-Burgos L, Wirtz VJ. Access to Medicines by Seguro Popular Beneficiaries: Pending Tasks towards Universal Health Coverage. PLoS One 2015; 10:e0136823. [PMID: 26407158 PMCID: PMC4583285 DOI: 10.1371/journal.pone.0136823] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 08/10/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE In the context of aiming to achieve universal health coverage in Mexico, this study compares access to prescribed medicines (ATPM) between Seguro Popular (SP) and non-SP affiliated outpatient health service users. MATERIALS AND METHODS ATPM by 6,123 users of outpatient services was analyzed using the National Health and Nutrition Survey 2012. Adjusted bi-probit models were performed incorporating instrumental variables. RESULTS 17.3% of SP and 10.1% of the non-SP population lacked ATPM. Two-thirds of all outpatient SP and 18.5% of all outpatient non-SP received health services at Ministry of Health facilities, among whom, 64.6 and 53.6% of the SP and non-SP population respectively reported ATPM at these facilities. Lack of medicines in health units, chronic health problems (compared to acute conditions) and prescription ≥3 medicines were risk factors for non-ATPM. Adjusted models suggest that when using Ministry of Health services, the SP population has a higher probability of ATMP compared to the non-SP population. CONCLUSION Given the aspirations of achieving universal health coverage in Mexico, it is important to increase ATPM in Ministry of Health facilities thereby ensuring basic rights to health care are met.
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Affiliation(s)
- Edson Servan-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Ileana Heredia-Pi
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Julio Montañez-Hernandez
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Leticia Avila-Burgos
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Veronika J. Wirtz
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
- Department for Global Health, Boston University School of Public Health, Boston, United States of America
- * E-mail:
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Silverman-Retana O, Lopez-Ridaura R, Servan-Mori E, Bautista-Arredondo S, Bertozzi SM. Cross-Sectional Association between Length of Incarceration and Selected Risk Factors for Non-Communicable Chronic Diseases in Two Male Prisons of Mexico City. PLoS One 2015; 10:e0138063. [PMID: 26381399 PMCID: PMC4575089 DOI: 10.1371/journal.pone.0138063] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 08/25/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Mexico City prisons are characterized by overcrowded facilities and poor living conditions for housed prisoners. Chronic disease profile is characterized by low prevalence of self reported hypertension (2.5%) and diabetes (1.8%) compared to general population; 9.5% of male inmates were obese. There is limited evidence regarding on the exposure to prison environment over prisoner's health status; particularly, on cardiovascular disease risk factors. The objective of this study is to assess the relationship between length of incarceration and selected risk factors for non-communicable chronic diseases (NCDs). METHODS AND FINDINGS We performed a cross-sectional analysis using data from two large male prisons in Mexico City (n = 14,086). Using quantile regression models we assessed the relationship between length of incarceration and selected risk factors for NCDs; stratified analysis by age at admission to prison was performed. We found a significant negative trend in BMI and WC across incarceration length quintiles. BP had a significant positive trend with a percentage change increase around 5% mmHg. The greatest increase in systolic blood pressure was observed in the older age at admission group. CONCLUSIONS This analysis provides insight into the relationship between length of incarceration and four selected risk factors for NCDs; screening for high blood pressure should be guarantee in order to identify at risk individuals and linked to the prison's health facility. It is important to assess prison environment features to approach potential risk for developing NCDs in this context.
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Affiliation(s)
- Omar Silverman-Retana
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Ruy Lopez-Ridaura
- Center for Population Health Research, National Institute of Public Health, Mexico City, Mexico
| | - Edson Servan-Mori
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Stefano M. Bertozzi
- School of Public Health. University of California, Berkeley, California, United States of America
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Servan-Mori E, Sosa-Rubí SG, Najera-Leon E, Darney BG. Timeliness, frequency and content of antenatal care: which is most important to reducing indigenous disparities in birth weight in Mexico? Health Policy Plan 2015; 31:444-53. [PMID: 26329891 DOI: 10.1093/heapol/czv082] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 11/13/2022] Open
Abstract
This article examines the role of components of adequate antenatal care (ANC) in disparities in birth weight between indigenous and non-indigenous women in Mexico. We estimate the potential for added weight gain among indigenous infants if their mothers received timely, frequent ( ≥4 visits) and complete ANC (≥75% of recommended processes of care). We used population-based survey data (2012;N= 6612 women 12-49). We applied quantile regression to examine heterogeneity of the association between adequate ANC, indigenous ethnicity and birth weight across quantiles of the birth weight distribution. A greater proportion of indigenous women reported a low-birth weight infant (<2.5 kg) at last delivery (14 vs 8% among non-indigenous women). Coverage of adequate ANC (timely, frequent and complete care) is lower among indigenous (59%, CI:53;65) than non-indigenous (68%, CI:66;70) women. Indigenous ethnicity is associated with a lower birth weight across quantiles of the observed birth weight distribution: between 300 g in the 0.05, 0.10 and 0.25 quantiles. Among indigenous women, greater newborn weight gains are achieved in the lowest quantiles if they have access to ≥75% of the content of ANC compared with those that did not have access: ∼180 and 260 g are gained in both quantiles 0.05 and 0.10, respectively. This means that the smallest indigenous newborns could potentially reach 2.36 kg (from 1.86 kg), close to the normal weight threshold. The frequency of ANC was positively associated with birth weight for all women but complete ANC appears to differentially affect indigenous women at the bottom of the birth weight distribution. The marginal gains obtained among indigenous newborns that received complete ANC compared with indigenous/non-indigenous newborns did not receive it, is particularly important in low-birth weight quantiles. Delivering basic processes of ANC may therefore have the potential to impact the highest risk women and help them to overcome the low-birth weight threshold.
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Affiliation(s)
- Edson Servan-Mori
- National Institute of Public Health, Mexico, Center for Health System Research
| | - Sandra G Sosa-Rubí
- National Institute of Public Health, Mexico, Center for Health System Research,
| | | | - Blair G Darney
- National Institute of Public Health, Mexico, Center for Health System Research, Oregon Health & Science University, Portland, OR, USA
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15
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Bautista-Arredondo S, González A, Servan-Mori E, Beynon F, Juarez-Figueroa L, Conde-Glez CJ, Gras N, Sierra-Madero J, Lopez-Ridaura R, Volkow P, Bertozzi SM. A Cross-Sectional Study of Prisoners in Mexico City Comparing Prevalence of Transmissible Infections and Chronic Diseases with That in the General Population. PLoS One 2015; 10:e0131718. [PMID: 26192811 PMCID: PMC4508056 DOI: 10.1371/journal.pone.0131718] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 06/04/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To describe patterns of transmissible infections, chronic illnesses, socio-demographic characteristics and risk behaviors in Mexico City prisons, including in comparison to the general population, to identify those currently needing healthcare and inform policy. MATERIALS AND METHODS A cross-sectional study among 17,000 prisoners at 4 Mexico City prisons (June to December 2010). Participation was voluntary, confidential and based on informed consent. Participants were tested for HIV, Hepatitis B & C, syphilis, hypertension, obesity, and, if at risk, glucose and cholesterol. A subset completed a questionnaire on socio-demographic characteristics and risk behaviors. Positive results were delivered with counseling and treatment or referral. RESULTS 76.8% (15,517/20,196) of men and 92.9% (1,779/1,914) of women participated. Complete data sets were available for 98.8%. The following prevalence data were established for transmissible infections: HIV 0.7%; syphilis: Anti-TP+/VDRL+ 2.0%; Hepatitis B: HBcAb 2.8%, HBsAg 0.15%; Anti-HCV 3.2%. Obesity: 9.5% men, 33.8% women. Compared with national age- and sex-matched data, the relative prevalence was greater for HIV and syphilis among women, HIV and Hepatitis C in men, and all infections in younger participants. Obesity prevalence was similar for women and lower among male participants. The prevalence of previously diagnosed diabetes and hypertension was lower. Questionnaire data (1,934 men, 520 women) demonstrated lower educational levels, increased smoking and substance use compared to national data. High levels of non-sterile tattooing, physical abuse and histories of sexual violence were found. CONCLUSION The study identified that health screening is acceptable to Mexico City prisoners and feasible on a large-scale. It demonstrated higher prevalence of HIV and other infections compared to national data, though low rates compared to international data. Individual participants benefited from earlier diagnosis, treatment and support. The data collected will also enable the formulation of improved policy for this vulnerable group.
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Affiliation(s)
| | | | | | | | | | | | | | - Juan Sierra-Madero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Servan-Mori E, Wirtz V, Avila-Burgos L, Heredia-Pi I. Antenatal Care Among Poor Women in Mexico in the Context of Universal Health Coverage. Matern Child Health J 2015; 19:2314-22. [DOI: 10.1007/s10995-015-1751-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Darney B, Sosa-Rubi S, Servan-Mori E, Rodriguez M, Walker D. Immediate postpartum contraception in Mexico: new data on the roles of age, insurance and mode and place of delivery. Contraception 2014. [DOI: 10.1016/j.contraception.2014.05.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Darney BG, Weaver MR, Sosa-Rubi SG, Walker D, Servan-Mori E, Prager S, Gakidou E. The Oportunidades conditional cash transfer program: effects on pregnancy and contraceptive use among young rural women in Mexico. Int Perspect Sex Reprod Health 2014; 39:205-14. [PMID: 24393726 DOI: 10.1363/3920513] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CONTEXT Oportunidades is a large conditional cash transfer program in Mexico. It is important to examine whether the program has any direct effect on pregnancy experience and contraceptive use among young rural women, apart from those through education. METHODS Data from the 1992, 2006 and 2009 waves of a nationally representative, population-based survey were used to describe trends in pregnancy experience, contraceptive use and education among rural adolescent (15-19) and young adult (20-24) women in Mexico. To examine differences in pregnancy experience and current modern contraceptive use among young women, multivariable logistic regression analyses were conducted between matched 2006 samples of women with and without exposure to Oportunidades, predicted probabilities were calculated and indirect effects were estimated. RESULTS Over the three survey waves, the proportion of adolescent and young adult women reporting ever being pregnant stayed flat (33-36%) and contraceptive use increased steadily (from 13% in 1992 to 19% in 2009). Educational attainment rose dramatically: The proportion of women with a secondary education increased from 28% in 1992 to 46% in 2009. In multivariable analyses, exposure to Oportunidades was not associated with pregnancy experience among adolescents. Educational attainment, marital status, pregnancy experience and access to health insurance--but not exposure to Oportunidades--were positively associated with current modern contraceptive use among adolescent and young adult women. CONCLUSION Through its effect on education, Oportunidades indirectly influences fertility among adolescents. It is important for Mexico to focus on strategies to increase contraceptive use among young rural nulliparous women, regardless of whether they are enrolled in Oportunidades.
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Affiliation(s)
- Blair G Darney
- Doctoral Student, Department of Health Services, School of Public Health, University of Washington, Seattle, USA,
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19
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Leyva-Flores R, Servan-Mori E, Infante-Xibille C, Pelcastre-Villafuerte BE, Gonzalez T. Primary health care utilization by the mexican indigenous population: the role of the Seguro popular in socially inequitable contexts. PLoS One 2014; 9:e102781. [PMID: 25099399 PMCID: PMC4123888 DOI: 10.1371/journal.pone.0102781] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 06/22/2014] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To analyze the relationship between primary health care utilization and extended health insurance coverage under the Seguro Popular (SP) among Mexican indigenous people. METHODOLOGY A cross-sectional analysis was conducted using data from the Mexican National Nutrition Survey 2012 (n = 194,758). Quasi-experimental matching methods and nonlinear regression probit models were used to estimate the influence of SP on primary health care utilization. RESULTS 25% of the Mexican population reported having no health insurance coverage, while 59% of indigenous versus 35% of non-indigenous reported having SP coverage. Health problems were reported by 13.9% of indigenous vs. 10.5% of non-indigenous; of these, 52.8% and 57.7% respectively, received primary health care (p<0.05). Economic barriers were the most frequent reasons for not using primary health care services. The probability of utilizing primary health care services was 11.5 percentage points higher (p<0.01) for indigenous SP affiliates in comparison with non-indigenous, in similar socioeconomic conditions. CONCLUSION Socioeconomic conditions, not ethnicity per-se, determine whether people utilize primary health care services. Therefore, SP can be conceived as a public policy strategy which acts as a social buffer by enhancing health care utilization regardless of ethnicity. Further analysis is required to explore the potential gaps as a result of SP coverage among socially vulnerable groups.
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Affiliation(s)
- Rene Leyva-Flores
- Centre for Health Systems Research of the National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Edson Servan-Mori
- Centre for Health Systems Research of the National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Cesar Infante-Xibille
- Centre for Health Systems Research of the National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | - Tonatiuh Gonzalez
- Centre for Health Systems Research of the National Institute of Public Health, Cuernavaca, Morelos, Mexico
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Pérez-Cuevas R, Doubova SV, Wirtz VJ, Servan-Mori E, Dreser A, Hernández-Ávila M. Effects of the expansion of doctors' offices adjacent to private pharmacies in Mexico: secondary data analysis of a national survey. BMJ Open 2014; 4:e004669. [PMID: 24852298 PMCID: PMC4039785 DOI: 10.1136/bmjopen-2013-004669] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To compare the sociodemographic characteristics, reasons for attending, perception of quality and associated out-of-pocket (OOP) expenditures of doctors' offices adjacent to private pharmacies (DAPPs) users with users of Social Security (SS), Ministry of Health (MoH), private doctor's offices independent from pharmacies and non-users. SETTING Secondary data analysis of the 2012 National Survey of Health and Nutrition of Mexico. PARTICIPANTS The study population comprised 25 852 individuals identified as having had a health problem 15 days before the survey, and a random sample of 12 799 ambulatory health service users. OUTCOME MEASURES Sociodemographic characteristics, reasons for attending healthcare services, perception of quality and associated OOP expenditures. RESULTS The distribution of users was as follows: DAPPs (9.2%), SS (16.1%), MoH (20.9%), private providers (15.4%) and non-users (38.5%); 65% of DAPP users were affiliated with a public institution (MoH 35%, SS 30%) and 35% reported not having health coverage. DAPP users considered the services inexpensive, convenient and with a short waiting time, yet they received ≥3 medications more often (67.2%, 95% CI 64.2% to 70.1%) than users of private doctors (55.7%, 95% CI 52.5% to 58.6%) and public institutions (SS 53.8%, 95% CI 51.6% to 55.9%; MoH 44.7%, 95% CI 42.5% to 47.0%). The probability of spending on consultations (88%, 95% CI 86% to 89%) and on medicines (97%, 95% CI 96% to 98%) was much higher for DAPP users when compared with SS (2%, 95% CI 2% to 3% and 12%, 95% CI 11% to 14%, respectively) and MoH users (11%, 95% CI 9% to 12% and 32%, 95% CI 30% to 34%, respectively). CONCLUSIONS DAPPs counteract current financial protection policies since a significant percentage of their users were affiliated with a public institution, reported higher OOP spending and higher number of medicines prescribed than users of other providers. The overprescription should prompt studies to learn about DAPPs' quality of care, which may arise from the conflict of interest implicit in the linkage of prescribing and dispensing processes.
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Affiliation(s)
- Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Inter-American Development Bank, Mexico, Mexico
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit, CMN Siglo XXI, Mexican Institute of Social Security, Mexico, Mexico
| | - Veronika J Wirtz
- Center for Global Health and Development (CGHD), Boston University, Boston, Massachusetts, USA
- Centre for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Edson Servan-Mori
- Centre for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Anahí Dreser
- Centre for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
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Servan-Mori E, Torres-Pereda P, Orozco E, Sosa-Rubí SG. An explanatory analysis of economic and health inequality changes among Mexican indigenous people, 2000-2010. Int J Equity Health 2014; 13:21. [PMID: 24576113 PMCID: PMC3996059 DOI: 10.1186/1475-9276-13-21] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 02/19/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Mexico faces important problems concerning income and health inequity. Mexico's national public agenda prioritizes remedying current inequities between its indigenous and non-indigenous population groups. This study explores the changes in social inequalities among Mexico's indigenous and non-indigenous populations for the time period 2000 to 2010 using routinely collected poverty, welfare and health indicator data. METHODS We described changes in socioeconomic indicators (housing condition), poverty (Foster-Greer-Thorbecke and Sen-Shorrocks-Sen indexes), health indicators (childhood stunting and infant mortality) using diverse sources of nationally representative data. RESULTS This analysis provides consistent evidence of disparities in the Mexican indigenous population regarding both basic and crucial developmental indicators. Although developmental indicators have improved among the indigenous population, when we compare indigenous and non-indigenous people, the gap in socio-economic and developmental indicators persists. CONCLUSIONS Despite a decade of efforts to promote public programs, poverty persists and is a particular burden for indigenous populations within Mexican society. In light of the results, it would be advisable to review public policy and to specifically target future policy to the needs of the indigenous population.
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Affiliation(s)
- Edson Servan-Mori
- National Institute of Public Health, Avenue Universidad 655, Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos, Mexico
| | - Pilar Torres-Pereda
- National Institute of Public Health, Avenue Universidad 655, Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos, Mexico
| | - Emanuel Orozco
- National Institute of Public Health, Avenue Universidad 655, Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos, Mexico
| | - Sandra G Sosa-Rubí
- National Institute of Public Health, Avenue Universidad 655, Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos, Mexico
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Servan-Mori E, Pelcastre-Villafuerte B, Heredia-Pi I, Montoya-Rodríguez A. Essential health care among Mexican indigenous people in a universal coverage context. Ethn Dis 2014; 24:423-430. [PMID: 25417424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVE To analyze the influence of indigenous condition on essential health care among Mexican children, older people and women in reproductive age. METHODS The influence of indigenous condition on the probability of receiving medical care due to acute respiratory infection (ARI) and acute diarrheal disease (ADD), vaccination coverage; and antenatal care (ANC) was analyzed using the 2012 National Health Survey and non-experimental matching methods. RESULTS Indigenous condition does not influence per-se vaccination coverage (in < 1 year), probability of attention of ARI's and ADD's as well as, timely, frequent, and quality ANC. Being indigenous and older adult increases 9% the probability of receiving a fulfilled vaccination schedule. CONCLUSION Unfavorable structural conditions in which Mexican indigenous live constitutes the persistent mechanisms of their health vulnerability. Public policy should consider this level of intervention, in a way that intensive and focalized health strategies contribute to improve their health condition and life.
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Servan-Mori E, Leyva-Flores R, Xibille CI, Torres-Pereda P, Garcia-Cerde R. Migrants Suffering Violence While in Transit Through Mexico: Factors Associated with the Decision to Continue or Turn Back. J Immigr Minor Health 2013; 16:53-9. [DOI: 10.1007/s10903-012-9759-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Heredia-Pi IB, Servan-Mori E, Reynales-Shigematsu LM, Bautista-Arredondo S. The maximum willingness to pay for smoking cessation method among adult smokers in Mexico. Value Health 2012; 15:750-758. [PMID: 22867786 DOI: 10.1016/j.jval.2012.03.1384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 02/24/2012] [Accepted: 03/17/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To estimate the maximum willingness to pay (WTP) for an effective smoking cessation treatment among smokers in Mexico and to identify the environmental, demographic, and socioeconomic factors associated with the WTP. METHODS A cross-sectional study was conducted. The sample contained 777 smokers (willingness to quit using a WTP of >0) who had responded to the 2009 Global Adult Tobacco Survey conducted in Mexico. Statistical associations and descriptive analyses were conducted to describe smokers and their WTP by using tobacco-related environmental, socioeconomic, and demographic variables. RESULTS Overall, 74.4% of the smokers were men and 51.4% were daily smokers. On average, the smokers had been consuming tobacco for more than 15 years, 58.6% had made cessation attempts in the past, and around 10.0% knew about the existence of centers to aid in smoking cessation. The average WTP for an effective cessation method was US $191. Among men, the WTP was US $152 lower than among women. In all the estimated models, the higher an individual's education and socioeconomic level, the higher his or her WTP. CONCLUSIONS This study suggests that Mexican smokers interested in quitting smoking attribute a high monetary value to an effective cessation method. Male smokers demonstrated less altruistic behavior than did female smokers. Mexico requires the implementation of more policies designed to support smoking cessation and to limit tobacco addiction. Expanding the availability of cessation programs and access to pharmacological treatments may contribute to reaching universal coverage by integrating new pharmacological alternatives into the health sector's medicine formulary.
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Affiliation(s)
- Ileana B Heredia-Pi
- Centre for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
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Wirtz VJ, Santa-Ana-Tellez Y, Servan-Mori E, Avila-Burgos L. Heterogeneous effects of health insurance on out-of-pocket expenditure on medicines in Mexico. Value Health 2012; 15:593-603. [PMID: 22867767 DOI: 10.1016/j.jval.2012.01.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 01/21/2012] [Accepted: 01/24/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Given the importance of health insurance for financing medicines and recent policy changes designed to reduce health-related out-of-pocket expenditure (OOPE) in Mexico, our study examined and analyzed the effect of health insurance on the probability and amount of OOPE for medicines and the proportion spent from household available expenditure (AE) funds. METHODS We conducted a cross-sectional analysis by using the Mexican National Household Survey of Income and Expenditures for 2008. Households were grouped according to household medical insurance type (Social Security, Seguro Popular, mixed, or no affiliation). OOPE for medicines and health costs, and the probability of occurrence, were estimated with linear regression models; subsequently, the proportion of health expenditures from AE was calculated. The Heckman selection procedure was used to correct for self-selection of health expenditure; a propensity score matching procedure and an alternative procedure using instrumental variables were used to correct for heterogeneity between households with and without Seguro Popular. RESULTS OOPE in medicines account for 66% of the total health expenditures and 5% of the AE. Households with health insurance had a lower probability of OOPE for medicines than their comparison groups. There was heterogeneity in the health insurance effect on the proportion of OOPE for medicines out of the AE, with a reduction of 1.7% for households with Social Security, 1.4% for mixed affiliation, but no difference between Seguro Popular and matched households without insurance. CONCLUSION Medicines were the most prevalent component of health expenditures in Mexico. We recommend improving access to health services and strengthening access to medicines to reduce high OOPE.
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Affiliation(s)
- Veronika J Wirtz
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
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