Barriers and Facilitators in Timely Detection of Chronic Kidney Disease: Evidences for Decision-Makers.

Chronic Kidney Disease (CKD) is classified, according to the glomerular filtratation rate. Timely diagnosis during the first three stages represents a lower expenditure for health systems in the treatment of this disease. Thus, this study intends to identify barriers and facilitators in timely detection of CKD, from the perspective of healthcare providers. This is an exploratory study of the qualitative type. A mapping of the literature was carried out in order to develop the following topics: perceptions of the implications of CKD for the health system at an international level and in Mexico, as well as experience related to barriers and facilitators in timely CKD detection in Mexico. Based on the identified topics, semi-structured interviews were carried out with decision-makers, operational personnel, civil and academic associations representatives in Mexico City and Cuernavaca, Morelos. The main identified barriers were: system fragmentation; overload of services at first and second levels of care; insufficient human resources; lack of updating of the clinical practice guide and scarce training. With respect to facilitators, we found there are civil society actions. Finally, requirements for timely detection of CKD are consistent with what is described in the international guides. The identification of barriers and facilitators in timely CKD detection gives us an outlook of the problem in Mexico and leads to proposals for action. The development of a national program with a strategy for timely detection of CKD may help unify inter-institutional criteria considering the protocols for clinical practice that take into account each institution's organization and resources.

Quantifying health impacts and economic costs of PM2.5 exposure in Mexican cities of the National Urban System.

OBJECTIVES: To estimate avoidable mortality, potential years of life lost and economic costs associated with particulate matter PM2.5 exposure for 2 years (2013 and 2015) in Mexico using two scenarios of reduced concentrations (i.e., mean annual PM2.5 concentration < 12 µg/m3 and mean annual PM2.5 concentration < 10 µg/m3). METHODS: The health impact assessment method was followed. This method consists of: identification of health effects, selection of concentration-response functions, estimation of exposure, quantification of impacts quantification and economic assessment using the willingness to pay and human capital approaches. RESULTS: For 2013, we included data from 62 monitoring sites in ten cities, (113 municipalities) where 36,486,201 live. In 2015, we included 71 monitoring sites from fifteen cities (121 municipalities) and 40,479,629 inhabitants. It was observed that reduction in the annual PM2.5 average to 10 µg/would have prevented 14,666 deaths and 150,771 potential years of life lost in 2015, with estimated costs of 64,164 and 5434 million dollars, respectively. CONCLUSIONS: Reducing PM2.5 concentration in the Mexican cities studied would reduce mortality by all causes by 8.1%, representing important public health benefits.

[Use of migrant's remittances from California on dependent's healthcare in Mexico]. / Utilización de remesas de migrantes en California para atención a la salud de sus dependientes en México.

OBJECTIVE: This paper focuses on public and private healthcare utilization among dependents living in Mexico of Mexican migrants in California, analyzing the link between remittances and enrollment in Seguro Popular, a social health insurance plan. MATERIALS AND METHODS: We surveyed 1353 migrants who visited the Mexican consulate of Los Angeles in 2010. RESULTS: 53.9% sent remittances; 72.2% of households receiving remittances used a share of remittances for health care and 74.4% of them were covered by Seguro Popular. The annual median with private health care expenditure was USD 825, compared to USD 293 for public providers. The main predictors remittances utilization for healthcare were having a sick dependent, purchase of prescription drugs, experiencing problems paying for health care and time of U.S. residence. CONCLUSIONS: Seguro Popular increases healthcare utilization with public providers, which provides an opportunity to reallocate the use of migrant's remittances for health purposes.

Utilización de remesas de migrantes en California para atención a la salud de sus dependientes en México / Use of migrant's remittances from California on dependent's healthcare in Mexico

Objetivo. Este trabajo se enfoca en la utilización de servicios públicos y privados por los dependientes de migrantes en México, analizando de manera particular su relación con remesas y afiliación al Seguro Popular. Material y métodos. Se aplicó un cuestionario a 1 353 migrantes en el Consulado de México en Los Ángeles en 2010. Resultados. 53.9% envía remesas; 72.2% de hogares receptores utilizan remesas para atención a la salud y 74.4% tienen Seguro Popular. La media de gasto en servicios privados fue 825 dólares anuales, comparado con 293 dólares con proveedores públicos. Los principales predictores del uso de remesas por salud fueron, familiares enfermos, compra de medicamentos, problemas para pagar y tiempo de residencia en EUA. Conclusiones. El Seguro Popular presenta una oportunidad para incidir en la eficiencia del gasto en salud proveniente de las remesas, mediante la promoción de la utilización de servicios públicos de salud entre los dependientes de migrantes.

Objective. This paper focuses on public and private healthcare utilization among dependents living in Mexico of Mexican migrants in California, analyzing the link between remittances and enrollment in Seguro Popular, a social health insurance plan. Materials and methods. We surveyed 1353 migrants who visited the Mexican consulate of Los Angeles in 2010. Results. 53.9% sent remittances; 72.2% of households receiving remittances used a share of remittances for health care and 74.4% of them were covered by Seguro Popular. The annual median with private health care expenditure was USD 825, compared to USD 293 for public providers. The main predictors remittances utilization for healthcare were having a sick dependent, purchase of prescription drugs, experiencing problems paying for health care and time of U.S. residence. Conclusions. Seguro Popular increases healthcare utilization with public providers, which provides an opportunity to reallocate the use of migrant's remittances for health purposes.