Cost of AIDS care in Mexico: what are its main individual predictors?

BACKGROUND: The Mexican government is offering universal access to antiretroviral (ARV) drugs. The cost of doing so, despite aggressive price negotiation with the pharmaceutical industry, remains high. Even with a low prevalence, about 150,000 Mexicans are estimated to be living with HIV and will require ARV treatment. Estimating the resources needed to fund this gap should consider how patient and provider characteristics affect health care costs. METHODS: Using a sample of patients from 11 facilities in three Mexican cities representing a large proportion of AIDS patients in the country, we developed a fixed-effect model, which by controlling the facilities and individual heterogeneity estimates predicted costs using patient demographic and socioeconomic characteristics as well as physician training. RESULTS: The estimated model explains about 45% of the variation in costs. Additional education is significantly and positively associated with cost. Increasing age is also associated with higher costs. CONCLUSIONS: Socioeconomic status and demographic characteristics explain an important proportion of variation in care costs for AIDS, despite AIDS being such a heterogeneous disease. Such characteristics will need to be taken into account when resource needs are estimated. A priority-setting process considering the principles of equity in the fair distribution of resources is needed to help reduce the social burden of HIV/AIDS in Mexico

Movilidad poblacional y VIH/sida en Centroamérica y México

OBJETIVO: Estimar la magnitud de la asociación entre la movilidad poblacional, medida con la tasa neta de migración (TNM) y la prevalencia de VIH en Centroamérica y México. MÉTODOS: Con modelos de series temporales se analizó dicha asociación en personas de 15 a 49 años de edad, ajustada por factores socioeconómicos (educación, educación, desempleo, esperanza de vida e ingreso) y utilizando información pública de ONUSIDA, el PNUD, la CEPAL y el Banco Mundial para el período 1990-2009. RESULTADOS: La TNM fue negativa en todos los países, excepto en Costa Rica y Panamá. Los resultados no ajustados del modelo muestran una asociación positiva y que la TNM puede explicar el 6% de la prevalencia de VIH registrada. Cuando se incluyen cofactores socioeconómicos por país (educación, salud e ingreso), la magnitud asciende a 9% (P<0,05). La TNM, incluso ajustada por factores socioeconómicos, explica modestamente la prevalencia de VIH registrada. Los factores socioeconómicos indican mejoras en todos los indicadores en Centroamérica y México, aunque persisten importantes brechas entre países. CONCLUSIONES: La modesta asociación observada entre movilidad poblacional y prevalencia de VIH está condicionada por la situación socioeconómica de los países estudiados. La información disponible limitó el alcance del análisis para establecer con mayor certeza la existencia de esta asociación. En consecuencia, con la información disponible no es posible atribuir a la migración un papel determinante en la diseminación del VIH

Does the new public management contribute to improving the performance of obstetric care in Mexico public hospitals?

In pursuit of higher performance in the Public Administration, the Mexican government implemented the New Public Management (NPM) model in 2008, with the aim of correcting deficiencies in its public services - including those of the Ministry of Health (MoH) -. In ten years of work under the new model, no information has been provided on the effects of NPM on the performance indicators, such as effectiveness and efficiency, of government institutions. The present study had the objective to analyze the impact of the NPM on the effectiveness and efficiency of MoH care facilities. Effectiveness was evaluated as the proportion of hospital discharges (HD) indicating a recovery diagnosis, and efficiency as the average length of hospital stays, modeled with survival analysis and local kernel regression methods. Data analyzed pertained to a time series of 16.5 million obstetric HD (64% of total discharges) produced from 2000 to 2015. The results revealed high levels of effectiveness (98% of HD with recovery diagnosis) and efficiency (an average hospital stay of 1.74 days), before and after NPM. The consistently high performance throughout the period analyzed, indicate that MoH hospitals had attained optimal effectiveness and efficiency levels prior to the NPM implementation. The indistinctive impact of the public management reform may suggest that NPM was applied as a blanket solution without considering institutional specificities.En la búsqueda de mejorar el desempeño de la administración pública, el gobierno mexicano implementó, en 2008, la Nueva Gestión Pública (NGP). Con este modelo se pretendía corregir las deficiencias en la provisión de servicios públicos, incluidos los otorgados por la Secretaría de Salud. A diez años de su implementación, se desconoce la contribución de la NGP en el desempeño de los hospitales de la Secretaría de Salud de México. El presente estudio analizó el impacto de la NGP en la efectividad y eficiencia (dos de los principales indicadores de desempeño hospitalario) de la atención obstétrica (la principal actividad hospitalaria -64% del total de egresos hospitalarios-) en la Secretaría de Salud. Los datos analizados corresponden a una serie temporal de 16,5 millones de egresos hospitalarios obstétricos producidos entre 2000 y 2015. La efectividad se midió como la proporción de egresos con diagnóstico de recuperación y la eficiencia como el promedio de día estancia. El cambio en la eficiencia, antes y después de la implementación de la NGP, se modeló con análisis de sobrevida y Regresión Kernel. Los resultados revelaron altos niveles de efectividad (98% de egresos hospitalarios con diagnóstico de recuperación) y eficiencia (una estancia hospitalaria promedio de 1,74 días), antes y después de NGP. El alto rendimiento, constante durante todo el período analizado, indica que los hospitales de la Secretaría de Salud alcanzaron, y conservaron, niveles óptimos de efectividad y eficiencia antes y después de la implementación de la NGP. La falta de impacto de esta reforma en la gestión pública puede sugerir que el NGP se aplicó como una solución general sin considerar las especificidades institucionales

Factores asociados con la búsqueda del servicio de interrupción legal del embarazo en la Ciudad de México, 2010 Factors associated with the seeking of legal induced abortion services in Mexico City in 2010

OBJETIVO: Identificar factores asociados con la búsqueda del servicio de interrupción legal del embarazo (ILE) en la Ciudad de México. MATERIAL Y MÉTODOS: Se utilizó un diseño casos-controles. Usuarias del servicio de ILE fueron definidas como casos, y usuarias de control prenatal con 13 o más semanas de gestación con un embarazo no deseado constituyeron los controles. Se ajustaron modelos de regresión logística condicional. RESULTADOS: Los años de escolaridad (RM=1.47, IC:1.04-2.07), la ocupación (estudiante, RM=7.31, IC:1.58-33.95; tener empleo remunerado, RM= 13.43, IC:2.04-88.54) y número de interrupciones de embarazo previas (RM=11.41, IC:1.65-79.07) se asociaron con la búsqueda de ILE. El factor de mayor peso fue la ocupación; las mujeres que trabajan tuvieron 13.4 veces mayor posibilidad de demandar el servicio de ILE. CONCLUSIONES: En el contexto de la Ciudad de México, mujeres con más educación y participación laboral activa utilizan más los servicios de ILE. Se requieren estrategias dirigidas a incrementar el uso de estos servicios por mujeres menos favorecidas.<br>OBJECTIVE: To identify factors associated with the seeking of the legal-interruption-pregnancy (LIP) services in Mexico City. MATERIALS AND METHODS: We used a case-control design. Users who utilized the LIP were defined as cases, while users of the antenatal care service with gestational age 13 or more weeks and who reported having an unwanted pregnancy were defined as controls. Logistic regressions were fitted to estimate odds ratios. RESULTS: Higher level of education (OR=1.47, 95% CI:1.04-2.07), women's occupation (being student OR=7.31, 95% CI:1.58-33.95; worker OR=13.43, 95% CI:2.04-88.54), and number of previous abortions (OR=11.41, 95% CI:1.65-79.07) were identified as factors associated with the lookup of LIP. CONCLUSIONS: In Mexico City context, empowered women with a higher level of education, or having a work activity are the users of LIP services. Strategies for improving access of women with low empowerment conditions are needed

Mexican household health expenditure as proportion of total expenditure according to presence of a member with diagnosed diabetes or hypertension.

<p>Mexican household health expenditure as proportion of total expenditure according to presence of a member with diagnosed diabetes or hypertension.</p

Mexico’s household health expenditure on diabetes and hypertension: What is the additional financial burden? - Fig 2

<p>Balance plots for the matching procedure: i) households having members with diabetes; ii) households having members with hypertension; iii) households having members with either diabetes or hypertension.</p

Mexico’s household health expenditure on diabetes and hypertension: What is the additional financial burden?

<div><p>Objective</p><p>This study aimed to estimate the magnitude of the association between overall household health expenditures & the presence of members with a chronic disease in the household.</p><p>Research design & methods</p><p>This was a cross-sectional analysis of a probabilistic household survey, which gathered data on previously diagnosed type 2 diabetes mellitus and hypertension as well as health expenditure in Mexico. From an analytic sample of 44,000 households, we identified those having at least one member with diabetes or hypertension and determined their health expenditure. Using matching procedures, we compared these data with those of households lacking such individuals.</p><p>Results</p><p>We found that 24% of the households had at least one member who had been diagnosed with diabetes, hypertension, or both. Households with such members reported health expenditures that were 25%–34% (<i>P</i> <0.01) higher than households without such individuals. Such differences were more pronounced among households at lower socioeconomic levels and among those with no or limited health insurance.</p><p>Conclusions</p><p>In addition to their impact on individual health, chronic ailments exert financial pressure on households. The additional health-care expenditure for households owing to such diseases leaves them financially exposed—especially households with lower income levels.</p></div

Average (95% confidence intervals) household quarterly health expenditures (in pesos) among Mexican households according to presence of household members with diagnosed diabetes or hypertension.

<p>Average (95% confidence intervals) household quarterly health expenditures (in pesos) among Mexican households according to presence of household members with diagnosed diabetes or hypertension.</p

Average (95% confidence interval) percentage of total household health among Mexican households according to presence of a member with diagnosed diabetes or hypertension.

<p>Average (95% confidence interval) percentage of total household health among Mexican households according to presence of a member with diagnosed diabetes or hypertension.</p

Difference (95% confidence interval) in total expenditure and percentage of total household health among Mexican households having a member with diagnosed diabetes or hypertension matched with households without such individuals.

<p>Difference (95% confidence interval) in total expenditure and percentage of total household health among Mexican households having a member with diagnosed diabetes or hypertension matched with households without such individuals.</p