An explanatory analysis of economic and health inequality changes among Mexican indigenous people, 2000-2010

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

Efectos heterogéneos en la demanda ante un impuesto al refresco en México

The increasing burden of obesity and related non-communicable diseases in the world has encouraged the design of effective policies in order to contain this trend. Excise taxes on low-nutritious food and sugar-sweetened beverages consumption, such as soft-drinks, have been proposed. Currently, a growing number of studies have calculated potential effects of soft-drinks taxes considering data for average consumers, and have assessed effectiveness of such measure on raising fresh revenues to the government, modifying consumption patterns, and population weight reduction. Nevertheless, there is evidence of heterogeneity of the demand of soft-drinks related to poverty and the level of consumption of soft-drinks. It has also been emphasised the need of examining the possible distributional effects of an excise tax in populations with uneven income distribution. We used Mexican data to discuss effectiveness and equity implications of an excise tax on soft-drinks consumption in populations with heterogeneous demand. We estimated the changes in the quantity purchased and household monthly expenditure on soft-drinks of 8434 households that answered the 2005 Mexican Family Life Survey. Specific price elasticities of the demand for soft-drinks of households grouped by their level of consumption (low, medium and high) and poverty (extreme, moderate and income superior to moderate poverty) were used. Several excise tax rate scenarios were considered: from a conservative level (tax rate: t=20%), to a least conservative level (t=65%) that was defined by the longitudinal analysis of body mass index changes in adults between 2002 and 2005. Effectiveness was evaluated by revenue collection (as a proportion of the cost of a comprehensive obesity prevention strategy), changes of the patterns of consumption and changes in calories related to changes of body mass index. Equity was assessed by concentration curves and indexes of the distribution of tax burden and the distribution of changes of the proportion of food expenditure devoted to soft-drink purchasing. The results suggest although revenues collected with low tax rates (20%) could partially finance a comprehensive obesity prevention strategy for Mexico, effectiveness on changing the patterns of consumption is only observable at tax rates higher than 45%. An excise tax is not effective on modifying population body mass index if tax rates are lower than 65%. Despite the fact that effects are concentrated in high consumption households, regressiveness is a latent problem due to the high tax burden imposed to households on extreme poverty. These results are different from the ones calculated in previous exercises in Mexico, considering average consumers. If governments are considering excise taxes on soft drinks to prevent obesity, heterogeneity of the demand for soft-drinks due to poverty and consumption level should be considered, especially in emergent economies with uneven income distribution. For the Mexican case, in order to design policies that adequately affect the demand for soft drinks, tax rates superior to 45% are recommended, along with redistributional mechanisms to promote equity by compensating households in extreme and moderate poverty, and effective interventions to reduce population weight

Efectos heterogéneos en la demanda ante un impuesto al refresco en México

The increasing burden of obesity and related non-communicable diseases in the world has encouraged the design of effective policies in order to contain this trend. Excise taxes on low-nutritious food and sugar-sweetened beverages consumption, such as soft-drinks, have been proposed. Currently, a growing number of studies have calculated potential effects of soft-drinks taxes considering data for average consumers, and have assessed effectiveness of such measure on raising fresh revenues to the government, modifying consumption patterns, and population weight reduction. Nevertheless, there is evidence of heterogeneity of the demand of soft-drinks related to poverty and the level of consumption of soft-drinks. It has also been emphasised the need of examining the possible distributional effects of an excise tax in populations with uneven income distribution. We used Mexican data to discuss effectiveness and equity implications of an excise tax on soft-drinks consumption in populations with heterogeneous demand. We estimated the changes in the quantity purchased and household monthly expenditure on soft-drinks of 8434 households that answered the 2005 Mexican Family Life Survey. Specific price elasticities of the demand for soft-drinks of households grouped by their level of consumption (low, medium and high) and poverty (extreme, moderate and income superior to moderate poverty) were used. Several excise tax rate scenarios were considered: from a conservative level (tax rate: t=20%), to a least conservative level (t=65%) that was defined by the longitudinal analysis of body mass index changes in adults between 2002 and 2005. Effectiveness was evaluated by revenue collection (as a proportion of the cost of a comprehensive obesity prevention strategy), changes of the patterns of consumption and changes in calories related to changes of body mass index. Equity was assessed by concentration curves and indexes of the distribution of tax burden and the distribution of changes of the proportion of food expenditure devoted to soft-drink purchasing. The results suggest although revenues collected with low tax rates (20%) could partially finance a comprehensive obesity prevention strategy for Mexico, effectiveness on changing the patterns of consumption is only observable at tax rates higher than 45%. An excise tax is not effective on modifying population body mass index if tax rates are lower than 65%. Despite the fact that effects are concentrated in high consumption households, regressiveness is a latent problem due to the high tax burden imposed to households on extreme poverty. These results are different from the ones calculated in previous exercises in Mexico, considering average consumers. If governments are considering excise taxes on soft drinks to prevent obesity, heterogeneity of the demand for soft-drinks due to poverty and consumption level should be considered, especially in emergent economies with uneven income distribution. For the Mexican case, in order to design policies that adequately affect the demand for soft drinks, tax rates superior to 45% are recommended, along with redistributional mechanisms to promote equity by compensating households in extreme and moderate poverty, and effective interventions to reduce population weight

Analysis of changes in the association of income and the utilization of curative health services in Mexico between 2000 and 2006

<p>Abstract</p> <p>Background</p> <p>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 <it>Seguro Popular</it>, 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.</p> <p>Methods</p> <p>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).</p> <p>Results</p> <p>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.</p> <p>Conclusions</p> <p>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 <it>Seguro Popular</it>, 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.</p

Incidence and time-varying predictors of HIV and sexually transmitted infections among male sex workers in Mexico City

Background Male sex workers are at high-risk for acquisition of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). We quantified incidence rates of STIs and identified their time-varying predictors among male sex workers in Mexico City. Methods From January 2012 to May 2014, male sex workers recruited from the largest HIV clinic and community sites in Mexico City were tested for chlamydia, gonorrhea, syphilis, hepatitis, and HIV at baseline, 6-months, and 12-months. Incidence rates with 95% bootstrapped confidence limits were calculated. We examined potential time-varying predictors using generalized estimating equations for a population averaged model. Results Among 227 male sex workers, median age was 24 and baseline HIV prevalence was 32%. Incidence rates (per 100 person-years) were as follows: HIV [5.23; 95% confidence interval (CI): 2.15–10.31], chlamydia (5.15; 95% CI: 2.58–9.34), gonorrhea (3.93; 95% CI: 1.88–7.83), syphilis (13.04; 95% CI: 8.24–19.94), hepatitis B (2.11; 95% CI: 0.53–4.89), hepatitis C (0.95; 95% CI: 0.00–3.16), any STI except HIV (30.99; 95% CI: 21.73–40.26), and any STI including HIV (50.08; 95% CI: 37.60–62.55). In the multivariable-adjusted model, incident STI (excluding HIV) were lower among those who reported consistently using condoms during anal and vaginal intercourse (odds ratio = 0.03, 95% CI: 0.00–0.68) compared to those who reported inconsistently using condoms during anal and vaginal intercourse. Conclusions Incidence of STIs is high among male sex workers in Mexico City. Consistent condom use is an important protective factor for STIs, and should be an important component of interventions to prevent incident infections

The disproportionate burden of HIV and STIs among male sex workers in Mexico City and the rationale for economic incentives to reduce risks

Introduction: The objective of this article is to present the rationale and baseline results for a randomized controlled pilot trial using economic incentives to reduce HIV and sexually transmitted infection (STI) risk among male sex workers (MSWs) in Mexico City. Methods: Participants (n=267) were tested and treated for STIs (chlamydia, gonorrhoea, syphilis and HIV) and viral hepatitis (hepatitis B and C), received HIV and STI prevention education and were randomized into four groups: (1) control, (2) medium conditional incentive ($50/six months), (3) high conditional incentive ($75/six months) and (4) unconditional incentive ($50/six months). In the conditional arms, incentives were contingent upon testing free of new curable STIs (chlamydia, gonorrhoea and syphilis) at follow-up assessments. Results: Participants’ mean age was 25 years; 8$25 with a 35% higher payment for condomless sex. Conclusions: The findings suggest that economic incentives are a relevant approach for HIV prevention among MSWs, given the market-based inducements for unprotected sex. This type of targeted intervention seems to be justified and should continue to be explored in the context of combination prevention efforts

Costo de la atención materno infantil en el estado de Morelos, México

Objetivo. Comparar el costo actual de servicios de salud materno infantiles (modelo actual) con el costo hipotético de su provisión bajo estándares definidos por el Paquete Madre Bebé, de la Organización Mundial de la Salud. Material y métodos. Se realizó un estudio piloto de caso, de corte transversal, en septiembre de 2001, en establecimientos de salud de la Jurisdicción Sanitaria III de los Servicios de Salud del Estado de Morelos, México. Se eligieron para el estudio dos centros de salud rurales, un centro de salud urbano y un hospital general de la Secretaría de Salud. Se calculó el costo total y por intervención del modelo actual y del modelo Paquete Madre Bebé, usando el Modelo de estimación de costos de este Paquete. Resultados. Se encontró que el costo total del Paquete Madre Bebé es dos veces mayor que el costo del modelo actual. De las 18 intervenciones evaluadas, la atención prenatal y el parto normal consumen la mayor proporción de los costos totales. Los costos de personal representan más de la mitad de los costos totales. Conclusiones. El Modelo de estimación de costos es una herramienta práctica para la estimación y comparación de costos, y es útil para guiar la distribución de recursos financieros destinados a la atención materno infantil. Sin embargo, su aplicación es de limitada utilidad si su adaptación no responde a las características de cada sistema de atención. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.htm

Costo de la atención materno infantil en el Estado de Morelos, México Cost of mother-child care in Morelos State

OBJETIVO: Comparar el costo actual de servicios de salud materno infantiles (modelo actual) con el costo hipotético de su provisión bajo estándares definidos por el Paquete Madre Bebé, de la Organización Mundial de la Salud. MATERIAL Y MÉTODOS: Se realizó un estudio piloto de caso, de corte transversal, en septiembre de 2001, en establecimientos de salud de la Jurisdicción Sanitaria III de los Servicios de Salud del Estado de Morelos, México. Se eligieron para el estudio dos centros de salud rurales, un centro de salud urbano y un hospital general de la Secretaría de Salud. Se calculó el costo total y por intervención del modelo actual y del modelo Paquete Madre Bebé, usando el Modelo de estimación de costos de este Paquete. RESULTADOS: Se encontró que el costo total del Paquete Madre Bebé es dos veces mayor que el costo del modelo actual. De las 18 intervenciones evaluadas, la atención prenatal y el parto normal consumen la mayor proporción de los costos totales. Los costos de personal representan más de la mitad de los costos totales. CONCLUSIONES: El Modelo de estimación de costos es una herramienta práctica para la estimación y comparación de costos, y es útil para guiar la distribución de recursos financieros destinados a la atención materno infantil. Sin embargo, su aplicación es de limitada utilidad si su adaptación no responde a las características de cada sistema de atención.OBJECTIVE: To compare the cost of maternal and child health care (current model) to that of the WHO Mother-Baby Package if it were implemented. MATERIAL AND METHODS: A pilot cross-sectional case study was conducted in September 2001 in Sanitary District No. III, Morelos State, Mexico. Two rural health centers, an urban health center, and a general hospital, all managed by the Ministry of Health, were selected for the study. The Mother-Baby Package Costing Spreadsheet was used to estimate the total cost and cost per intervention for the current model and for the Mother-Baby Package model. RESULTS: The total cost of the Mother-Baby Package was twice the cost of the current model. Of the 18 interventions evaluated, the highest proportion of total costs corresponded to antenatal care and normal delivery. Personnel costs represented more than half of the total costs. CONCLUSIONS: The Mother-Baby Package Costing Spreadsheet is a practical tool to estimate and compare costs and is useful to guide the distribution of financial resources allocated to maternal and child healthcare. However, this model has limited application unless it is adapted to the structure of each healthcare system

Diabetes treatment and control: the effect of public health insurance for the poor in Mexico

OBJECTIVE: To analyse the effect of enrolment in the public health insurance scheme known as Seguro Popular [People's Insurance] on access to health resources, treatment and blood glucose control among poor adults with diabetes in Mexico. METHODS: We analysed cross-sectional data from the 2006 National Health and Nutrition Survey and compared health care access and biological health outcomes, specifically glycosylated haemoglobin (HbA1c) levels, among adults with diabetes who were enrolled in the Seguro Popular (treatment group) and those who had no health insurance (control group). Standard propensity score matching was used to create a highly comparable control group. FINDINGS: Adults with diabetes who were enrolled in the Seguro Popular had significantly more access than comparable uninsured adults to some type of blood glucose control test (by a difference of 9.5 percentage points; 95% confidence interval, CI: 2.4-16.6) and to insulin injections (3.13 more per week; 95% CI: 0.04-6.22). Those with insurance were also significantly more likely to have appropriately-controlled blood glucose levels (HbA1c 12%) was found in a significantly smaller proportion of adults in the insured group than in the uninsured group (by a difference of 17.5 percentage points; 95% CI: 6.5-28.5). CONCLUSION: The Seguro Popular appears to have improved access to health care and blood glucose control among poor adults with diabetes in Mexico, and it may have had a positive effect on the management of other chronic health conditions, but its long-term effects are yet to be demonstrated. Although the findings are most relevant to Mexico, they may also be applicable to other developing countries seeking to improve health-care coverage for the poor by expanding their public health insurance programmes