Evaluación inicial del seguro popular sobre el gasto catastrófico en salud en méxico

Objetivo Estimar el resultado inicial del Seguro Popular de Salud (SPS) sobre elgasto catastrófico en salud (GC) de los hogares. Adicionalmente se estimó la relación de otros factores de importancia sobre el GC.Material y métodos Estudio transversal a partir de la Encuesta de Evaluación del Seguro Popular levantada en los estados de Colima y Campeche en el segundo semestre del año 2002. El estudio se llevó a cabo en el primer semestre del año 2005. Se estimó primero la relación del SPS y otras covariables con el GC mediante un modelo probit. Después se estimó nuevamente la relación de las covariables y el GC tomando en cuenta la endogeneidad del GC con la afiliación al SPS, utilizando para ello un modelo probit bivariado. Finalmente, se realizaron algunas simulaciones para ver con más detalle la influencia de la utilización por tipo de servicio sobre el GC.Resultados Para los hogares afiliados al SPS la probabilidad de incurrir en GC fue casi 8 % menor, en comparación con los hogares no afiliados, controlando por las demás covariables y se corrigió por la endogeneidad. La probabilidad de GC siempre fue menor para los afiliados, independientemente del tercil económico al que pertenecían y del tipo de servicio utilizado.Conclusiones Los resultados del estudio sugieren que el SPS está protegiendofinancieramente a los hogares; sin embargo, aún constituye un reto llegar a la meta de reducción del 75 % del GC

Results of certification audit in Mexican hospitals, a review from 2009 to 2012

Objective. To analyze the participation of Mexican hospitals in the certification process (equivalent to accreditation in other countries). Materials and methods. Crosssectional study that analyzes results of 136 establishments audited between 2009 and 2012. Standards with an excellent rating (9.0-10.0), approving (6-8.9) and non-approving (0-5.9) were identified. With a multinomial model, the probability of obtaining non-approving, approving and excellent qualification was calculated. Results. The general average score was 7.72, higher in ambulatory surgery centers (9.10), than in general hospitals (7.30) and specialty hospitals (7.99). All public establishments obtained an approval score. Hospitals audited in 2011 had a higher risk of obtaining an approval (RRR= 4.6, p<0.05) and excellent (RRR= 6.6, p<0.05) rating. Conclusions. The scope of the certification process in Mexico has been limited, with greater participation of the private sector. The evaluation certificate applied in 2011 favored the achievement of approval and excellence results. We recommend homologating the entire process with that of the Joint Commission International JCI

Condicionantes institucionales que influyen en la utilización del examen clínico de mama Institutional factors contributing to the utilization of breast clinical examination

OBJETIVO: Identificar los condicionantes de la utilización del examen clínico de mama, la relación entre ellos y el ejercicio médico institucional. MATERIAL Y MÉTODOS: Entre 1996 y 1997 se hizo un estudio cualitativo en unidades médicas del Instituto Mexicano del Seguro Social y de la Secretaría de Salud. Se realizaron ocho grupos focales: cuatro con mujeres usuarias y cuatro con profesionales de la salud. Participaron 47 usuarias y 29 médicos y enfermeras. La información se interpretó con base en la capacidad de respuesta organizacional a las expectativas de la usuaria, el poder/saber en la organización y el ejercicio médico institucional, a la luz de la Teoría Fundamentada. RESULTADOS: La demanda estuvo condicionada por la percepción de mala calidad de la atención, falta de confianza en el médico y aspectos organizacionales. En la oferta, los médicos varones mostraron desinterés y temor a realizar el examen. Las médicas parecieron interesadas y las usuarias las aceptaron. CONCLUSIONES: Existen barreras psicológicas, culturales, sociales e institucionales en el acceso y utilización del examen clínico de mama. La identificación de estas barreras y su origen pueden apoyar el desarrollo de acciones para mejorar la relación médico-paciente.OBJECTIVE:To identify factors associated with utilization of breast clinical examination (BCE) and their relationship with institutional medical practice. MATERIAL AND METHODS: This is a qualitative study conducted between 1996 and 1997 in medical units of Instituto Mexicano del Seguro Social (Mexican Institute of Social Security) and Secretaría de Salud (Ministry of Health). Eight focus groups were included: four groups of female users and four groups of health professionals; in total, 47 users and 29 physicians and nurses participated. Interpretations of information were based on the organizational ability to respond to the user's expectations, "ability/knowledge" within the organization and the institutional medical practice, at the light of the Grounded Theory. RESULTS: Service demand was conditioned on the perception of poor quality of care, lack of trust in physicians, and organizational aspects. When providing care, male physicians were not interested and felt uneasy about performing the BCE. Female physicians seemed more interested and were well accepted by users. CONCLUSIONS: Psychological, cultural, social, and institutional barriers exist in the access and utilization of BCE. Identifying these barriers and their origins could support the development of actions to improve the physician-patient relationshi

Construction and pilot test of a set of indicators to assess the implementation and effectiveness of the who safe childbirth checklist

Abstract Background The World Health Organization (WHO) launched the “Safe Childbirth Checklist (SCC) Collaboration” in 2012. The SCC is designed to contribute to quality care by providing reminders of evidence-based practices for the prevention and management of the leading causes of maternal and neonatal morbidity and mortality. However, indicators to monitor the implementation and effectiveness of the SCC have not been defined. This study aimed to produce and pilot test a set of valid, reliable and feasible indicators to assess the implementation and effectiveness of the SCC, with an emphasis on best practices. Methods As part of the WHO Collaboration, the SCC was adapted to the Mexican context, and a set of indicators was developed to assess the SCC use and adherence to SCC-related best practices. The indicators were pilot tested in three hospitals for feasibility and reliability using the prevalence- and bias-adjusted kappa index (PABAK) for multiple independent evaluators (initial sample, n = 47; second sample, n = 30 to re-test reliability). The data sources were clinical records and cognitive tests drawn from questionnaires to mothers and health professionals. Results We generated 53 indicators, and 38 of the indicators (those related to best practices and outcomes) were pilot tested. Of these, 26 relate to care for the mother (20 were measured based on clinical records and 6 via questionnaire), and 12 relate to newborn care (9 were medical record-based and 3 were from questionnaires). Feasible indicators were generally also reliable (PABAK≥0.6). Routine feasibility is affected by the frequency of assessed events. Conclusions The generated indicators allow an assessment of the implementation and effectiveness of the SCC and the monitoring of quality of care during childbirth and the immediate postpartum period

Indicators for monitoring maternal and neonatal quality care: a systematic review

Abstract Background Research and different organizations have proposed indicators to monitor the quality of maternal and child healthcare, such indicators are used for different purposes. Objective To perform a systematic review of indicators for the central phases of the maternal and child healthcare continuum of care (pregnancy, childbirth, newborn care and postpartum). Method A search conducted using international repositories, national and international indicator sets, scientific articles published between 2012 and 2016, and grey literature. The eligibility criteria was documents in Spanish or English with indicators to monitor aspects of the continuum of care phases of interest. The identified indicators were characterized as follows: formula, justification, evidence level, pilot study, indicator type, phase of the continuum, intended organizational level of application, level of care, and income level of the countries. Selection was based on the characteristics associated with scientific soundness (formula, evidence level, and reliability). Results We identified 1791 indicators. Three hundred forty-six were duplicated, which resulted in 1445 indicators for analysis. Only 6.7% indicators exhibited all requirements for scientific soundness. The distribution by the classifying variables is clearly uneven, with a predominance of indicators for childbirth, hospital care and facility level. Conclusions There is a broad choice of indicators for maternal and child healthcare. However, most indicators lack demonstrated scientific soundness and refer to particular continuum phases and levels within the healthcare system. Additional efforts are needed to identify good indicators for a comprehensive maternal and child healthcare monitoring system

Additional file 1: of Construction and pilot test of a set of indicators to assess the implementation and effectiveness of the who safe childbirth checklist

Mexico Safe Childbirth Checklist for mother and newborn (spanish). The original WHO Safe Childbirth Checklist was refined and adapted to the Mexican context. (PDF 5695 kb

Additional file 2: of Construction and pilot test of a set of indicators to assess the implementation and effectiveness of the who safe childbirth checklist

Mexico Safe Childbirth Checklist for mother and newborn (english). The original WHO Safe Childbirth Checklist was refined and adapted to the Mexican context and translated to english language. (PDF 458 kb

Additional file 3: of Construction and pilot test of a set of indicators to assess the implementation and effectiveness of the who safe childbirth checklist

Set of SCC indicators (spanish version). The detailed definitions of the indicators in Spanish. (DOCX 116 kb

Additional file 4: of Construction and pilot test of a set of indicators to assess the implementation and effectiveness of the who safe childbirth checklist

Set of SCC indicators (english version). The detailed definitions of the indicators in English. (DOCX 139 kb