RESUMO
The objective of this study was to evaluate the technical efficiency of Mexico's public health system in the delivery of obstetric care from 2012 to 2018. A multi-stage quantitative study of the public health institutions responsible for 95% of the system's obstetric services was conducted using data envelopment analysis. The efficiency of state-level productive units (decision-making units, or DMUs) was calculated and juxtaposed with the DMUs' maximum (0.82) and minimum (0.22) scores. Using the outcomes of the initial stage, the average technical efficiency of each institution at the national level was estimated and compared. The results were also utilized to estimate and compare the average efficiency of each state-level health system based on economic characteristics (state GDP per capita). Outputs included prenatal visits and deliveries, while inputs comprised gynecologists, exam rooms, and delivery rooms. Institutional efficiency ranged from 0.16 to 0.82, with an average of 0.417. The Ministry of Health (0.82) and the Mexican Social Security Institute (0.747) exhibited the highest efficiency scores, while the remaining institutions (Institute for Social Security and Services for State Workers [ISSSTE]; Mexican Petroleum [PEMEX]; the Secretary of National Defense [SEDENA]; and the Navy [SEMAR]) scored below the health system average. Of the 153 DMUs, 20% surpassed the maximum (0.82) and 40.6% fell below the minimum (0.22). These findings indicate that 80% of DMUs have unused operational capacity that could be utilized to enhance technical efficiency. No relationship was found between efficiency and the GDP of Mexico's 32 politico-administrative divisions. The efficiency gap between institutions (0.66) shows that while some DMUs are saturated (exhibiting high efficiency scores), the majority have unused operational capacity. Leveraging this untapped capacity could address the needs of vulnerable populations facing restricted access due to health system fragmentation.
RESUMO
Resumen Antecedentes: La emergencia sanitaria por COVID-19 causó un aumento de la demanda por hospitalización y costos elevados para el sistema de salud. Objetivo: Estimar los costos directos de la atención por COVID-19 desde la perspectiva del proveedor de servicios en un hospital de segundo nivel que fue reconvertido durante el primer año de la emergencia sanitaria. Material y métodos: Estudio observacional retrospectivo. La información sobre cantidades de bienes y servicios se obtuvo de los sistemas de información SINOLAVE y CVOED, así como de fuentes administrativas del hospital. Se definieron cuatro grupos de costos y se valoraron en dólares norteamericanos con precios unitarios de 2021. Resultados: La duración promedio de la estancia hospitalaria (n = 3241 pacientes) fue de 10.8 ± 8.2 días. El costo promedio de la atención por paciente fue de USD 6 557 ± 4 997. La terapia respiratoria con ventilación mecánica asistida fue utilizada por 13 % de los pacientes. Conclusiones: Los costos médicos de atención por COVID-19 representaron una gran cantidad de recursos. La mayor parte de los costos (95 %) se derivó de estancia hospitalaria, terapia respiratoria sin ventilación mecánica asistida, así como de costos relacionados con equipo de protección personal, higiene, adecuación a la infraestructura y pagos al personal médico.
Abstract Background: COVID-19 health emergency caused an increase in the demand for hospitalization and high costs for the health system. Objective: To estimate COVID-19 care direct costs from the perspective of the healthcare provider in a secondary care hospital that underwent conversion during the first year of health emergency. Material and methods: Retrospective, observational study. Information on quantities of goods and services was obtained from the SINOLAVE and CVOED platforms and from hospital administrative sources. Four cost groups were defined and estimated with 2021 unit prices in US dollars. Results: Mean hospital length of stay (n = 3,241 patients) was 10.8 ± 8.2 days. Average cost of care per patient was USD 6,557 ± 4,997. Respiratory therapy with assisted mechanical ventilation was used by 13% of patients. Conclusions: The costs of COVID-19 medical care represent a large amount of resources. Most part of the costs (95%) were derived from hospital stay, respiratory therapy without assisted mechanical ventilation and costs related to personal protective equipment, hygiene, infrastructure adaptation and payments to medical personnel.
RESUMO
El objetivo fue estimar el costo médico directo de la atención a embarazos atribuibles a la falla en la política de prevención de embarazos adolescentes en México. Estudio económico que estimó, desde la perspectiva del proveedor, el costo medio de atención prenatal, parto, puerperio, aborto y complicaciones. Para cuantificar los costos atribuibles a la falla de la política, se construyeron tres escenarios: (a) embarazos totales; (b) embarazos por arriba de la meta; (c) embarazos no deseados. También se estimó el costo de proveer anticonceptivos y se describieron características de las adolescentes embarazadas. De las adolescentes (n = 5.477.027), 30,2% había iniciado vida sexual; 46,8% usaba anticonceptivo; 44,1% se había embarazado y 9,1% abortó. La mayoría de embarazadas (65%) estudió secundaria o menos; 30% abandonó la escuela; 72,5% vivían en pareja; 72,3% presentó complicaciones. El costo medio de atención del embarazo se estimó en USD 2.210,55 y el de proveer anticonceptivos en USD 64,95. El costo total por la falla de la política se estimó para cada escenario (en millones): (a) USD 1.614,39, (b) USD 876,61 y (c) USD 171,50, respectivamente; mientras que el costo anual de proveer anticonceptivos en cada escenario se estimó en: (a) USD 47,43, (b) USD 25,76 y (c) USD 5,04. La falla de la política se expresa en alta frecuencia de embarazo en adolescentes de bajos ingresos y en altos costos para el sistema de salud. La provisión de anticonceptivos es 34 veces más barata que la atención de embarazos y podría, aunado al mejoramiento de las condiciones de vida, contribuir a disminuir la frecuencia de embarazos en adolescentes.
The objective was to estimate the direct medical cost of pregnancy care attributable to the failure of Mexico's teenage pregnancy prevention policy. From the provider's perspective, this economic study estimated the mean cost of prenatal care, childbirth, puerperium, abortion and complications. To quantify the costs attributable to policy failure, three scenarios were constructed: (a) total number of pregnancies; (b) number of pregnancies above the target; (c) number of unwanted pregnancies. The cost of providing contraceptive methods was also estimated and the characteristics of pregnant adolescents were described. Of the adolescents (n = 5,477,027), 30.2% were sexually active; 46.8% used contraception; 44.1% had become pregnant and 9.1% had an abortion. Most pregnant women (65%) attended secondary school or under; 30% dropped out of school; 72.5% lived with a partner; 72.3% had complications. The mean cost of pregnancy care was estimated at USD 2,210.55 and the mean cost of providing contraceptives at USD 64.95. The total cost of policy failure was estimated for each scenario (in millions): (a) USD 1,614.39, (b) USD 876.61 and (c) USD 171.50, respectively; whereas the annual cost of providing contraceptives in each scenario was estimated in: (a) USD 47.43, (b) USD 25.76 and (c) USD 5.04. The failure of the policy is expressed in the high frequency of pregnancy in low-income adolescents and in high costs for the health system. The provision of contraceptives is 34 times cheaper than pregnancy care and could, together with improved living conditions, contribute to reduce the frequency of adolescent pregnancies.
O objetivo deste estudo foi estimar os custos médicos diretos da assistência à gravidez relacionados ao fracasso da política de prevenção à gravidez na adolescência no México. Este estudo econômico avaliou, a partir da perspectiva da prestação de serviços, os custos médios do pré-natal, parto, puerpério, aborto e complicações da gravidez na adolescência. Para quantificar os custos relacionados ao fracasso dessa política de assistência, foram analisados três cenários: (a) total das gestações; (b) gravidez acima da média; (c) gravidez indesejada. Também foi estimado o custo do fornecimento de anticoncepcionais e descritas as características da gravidez na adolescência. Do total de adolescentes grávidas (n = 5.477.027), 30,2% tinham iniciado a vida sexual; 46,8% usavam métodos anticoncepcionais; 44,1% engravidaram e 9,1% abortaram. A maioria das grávidas (65%) tinha o ensino médio completo ou nível de escolaridade inferior; 30% abandonaram a escola; 72,5% moravam com o companheiro; e 72,3% apresentaram complicações. O custo médio da assistência à gravidez foi estimado em USD 2.210,55, e o do fornecimento de anticoncepcionais em USD 64,95. O custo total do fracasso dessa política foi estimado para cada cenário (em milhões): (a) USD 1.614,39, (b) USD 876,61 e (c) USD 171,50, respectivamente; enquanto o custo anual do fornecimento de contraceptivos em cada cenário foi: (a) USD 47,43, (b) USD 25,76 e (c) USD 5,04. O fracasso dessa política esteve relacionado à alta frequência de gravidez em adolescentes de baixa renda e aos altos custos para o sistema de saúde. A oferta de anticoncepcionais é 34 vezes mais barata do que a assistência à gravidez e pode contribuir para a redução da gravidez na adolescência, junto com uma melhoria nas condições de vida dessa população.
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Gravidez na Adolescência/prevenção & controle , Brasil , Anticoncepção/métodos , Anticoncepcionais , Políticas , MéxicoRESUMO
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.
OBJECTIVE: Estimate the magnitude of the association between population mobility, measured by net migration rate (NMR), and HIV prevalence in Central America and Mexico. METHODS: Using time series models, based on public information from UNAIDS, UNDP, ECLAC, and the World Bank for the period 1990-2009, this association was studied in individuals aged 15-49 years, and adjusted for socioeconomic factors (education, unemployment, life expectancy, and income). RESULTS: NMR was negative in all countries except Costa Rica and Panama. Unadjusted results of the model show a positive association and that NMR can explain 6% of recorded HIV prevalence. When socioeconomic cofactors are included by country (education, health, and income), the magnitude increases to 9% (P<0.05). NMR, even when adjusted for socioeconomic factors, explains some of recorded HIV prevalence. All socioeconomic indicators show improvements in Central America and Mexico, although large gaps persist among countries. CONCLUSIONS: The modest association observed between population mobility and HIV prevalence is conditioned by the socioeconomic status of the countries studied. Information availability limited the study’s ability to establish the existence of this association with greater certainty. Accordingly, based on available information, it is not possible to affirm that migration plays a key role in the spread of HIV.
Assuntos
Infecções por HIV/transmissão , Infecções por HIV/epidemiologia , HIV/patogenicidadeRESUMO
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.
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.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Gravidez , Adulto Jovem , Aspirantes a Aborto/estatística & dados numéricos , Aborto Legal/estatística & dados numéricos , Estudos de Casos e Controles , Escolaridade , Renda , Cobertura do Seguro , Estado Civil , México , Ocupações , Paridade , Gravidez não Desejada , Inquéritos e Questionários , Religião , População UrbanaRESUMO
OBJETIVO: Presentar y analizar información de costo-efectividad de intervenciones propuestas por la Iniciativa Mesoamericana de Salud (IMS) en las áreas de nutrición infantil, inmunizaciones, paludismo, dengue y salud materno-infantil y reproductiva. MATERIAL Y MÉTODOS: Se llevó a cabo una revisión sistemática de la literatura de evaluaciones económicas publicadas entre el año 2000 y agosto 2009 sobre intervenciones en las áreas de la salud mencionadas, en los idiomas inglés y español. RESULTADOS: Las intervenciones en nutrición y de salud materno-infantil mostraron ser altamente costo-efectivas (con rangos menores a US$200 por año de vida ajustado por discapacidad [AVAD] evitado para nutrición y US$100 para materno-infantil). En dengue sólo se encontró información sobre la aplicación de larvicidas, cuya razón de costo efectividad estimada fue de US$40.79 a US$345.06 por AVAD evitado. Respecto al paludismo, las intervenciones estudiadas resultaron costo-efectivas (
OBJECTIVE: Present and analyze cost-effectiveness information of public health interventions proposed by the Mesoamerican Health Initiative in child nutrition, vaccination, malaria, dengue, and maternal, neonatal, and reproductive health. MATERIAL AND METHODS: A systematic literature review was conducted on cost-effectiveness studies published between January 2000 and August 2009 on interventions related to the health areas previously mentioned. Studies were included if they measured effectiveness in terms of Disability-Adjusted Life Year (DALY) or death averted. RESULTS: Child nutrition and maternal and neonatal health interventions were found to be highly cost-effective (most of them below US$200 per DALY averted for nutritional interventions and US$100 for maternal and neonatal health). For dengue, information on cost-effectiveness was found just for application of larvicides, which resulted in a cost per DALY averted ranking from US$40.79 to US$345.06. Malarial interventions were found to be cost-effective (below US$150 per DALY averted or US$4,000 per death averted within Africa). In the case of pneumococcus and rotavirus vaccination, cost-effectiveness estimates were always above one GDP per capita per DALY averted. CONCLUSIONS: In Mesoamerica there are still important challenges in child nutrition, vaccination, malaria, dengue and maternal, neonatal, and reproductive health, challenges that could be addressed by scaling-up technically feasible and cost-effective interventions.
Assuntos
Animais , Criança , Feminino , Humanos , Gravidez , Bibliometria , Análise Custo-Benefício/estatística & dados numéricos , Promoção da Saúde/estatística & dados numéricos , Saúde Pública/estatística & dados numéricos , América Central , Serviços de Saúde da Criança/economia , Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/estatística & dados numéricos , Custos e Análise de Custo , Dengue/prevenção & controle , Países em Desenvolvimento , Promoção da Saúde/economia , Promoção da Saúde/organização & administração , Programas de Imunização/economia , Programas de Imunização/organização & administração , Programas de Imunização/estatística & dados numéricos , Cooperação Internacional , Malária/prevenção & controle , Desnutrição/prevenção & controle , Serviços de Saúde Materna/economia , Serviços de Saúde Materna/organização & administração , Serviços de Saúde Materna/estatística & dados numéricos , México , Controle de Mosquitos/economia , Controle de Mosquitos/organização & administração , Controle de Mosquitos/estatística & dados numéricos , Serviços Preventivos de Saúde/economia , Serviços Preventivos de Saúde/organização & administração , Serviços Preventivos de Saúde/estatística & dados numéricos , Serviços de Saúde Reprodutiva/economia , Serviços de Saúde Reprodutiva/organização & administração , Serviços de Saúde Reprodutiva/estatística & dados numéricosRESUMO
OBJETIVO. Documentar los procesos operativos y de gestión del Fondo de Protección contra Gastos Catastróficos (FPGC), evolución y distribución del gasto y explorar semejanza entre padecimientos cubiertos y perfil epidemiológico. MATERIAL Y MÉTODOS. Estudio mixto, de naturaleza gerencial, que incluyó entrevistas semiestructuradas, revisión de bases de datos de la Comisión Nacional de Protección Social en Salud (CNPSS), egresos hospitalarios y mortalidad. RESULTADOS. El 52 por ciento de los estados tardan el doble del tiempo establecido para notificar y validar los casos. De 2004 a 2009 el FPGC pasó de 6 a 49 intervenciones, equivalente a un incremento nominal y real del gasto de 2 306.4 y 1 659.3 por ciento, respectivamente. La intervención priorizada fue VIH/SIDA con 39.3 por ciento; el Distrito Federal obtuvo la mayor proporción del gasto (25.1 por ciento). Algunas de las principales causas de mortalidad son cubiertas por el FPGC. CONCLUSIONES. La revisión de los criterios de inclusión de enfermedades y la adecuación del fondo para atender la demanda creciente es impostergable.
OBJECTIVE. To document the status of operational and managerial processes of the Fund for Protection against Catastrophic Expenses (FPGC), as well as to describe its evolution, and to explore the relationship between covered diseases and the Mexican health profile. MATERIAL AND METHODS. This is a joint management study, which included a qualitative and a quantitative phase. We conducted semi-structured interviews with key informants. We also analyzed the records of CNPSS, the hospital discharge and mortality data bases. RESULTS. Fifty two percent of the states take twice as long to report and validate the cases. From 2004-2009 the FPGC increased its coverage from 6 to 49 interventions, that means a spending increase of 2 306.4 percent in nominal terms and 1 659.3 percent in real terms. The HIV/AIDS was the intervention prioritized with 39.3 percent and Mexico City had the highest proportion of expenditure (25.1 percent). A few diseases included in the health profile are covered by the FPGC. CONCLUSIONS. The review of the inclusion criteria of diseases is urgent, so as to cover diseases of epidemiological importance.
Assuntos
Humanos , Seguro Médico Ampliado , Doença Catastrófica/economia , Doença Catastrófica/epidemiologia , MéxicoAssuntos
Migração Humana , HIV , Prevalência , América Central , México , HIV , Prevalência , América Central , Migração HumanaRESUMO
OBJETIVO: Determinar la prevalencia y distribución de los accidentes de tránsito no fatales (ATNF) en México. MATERIAL Y MÉTODOS: Se utilizaron datos de la ENSANUT 2006. En los hogares visitados se seleccionó a un adulto, un adolescente y un niño, hasta conformar una muestra de 94197 sujetos que representa a la N de 102 886 482 individuos. La variable dependiente fue la prevalencia de ATNF en los 12 meses anteriores a la encuesta. RESULTADOS: La prevalencia de accidentes (de tránsito o no) fue de 6.0 por ciento y de esa cifra 16.7 por ciento correspondió a ATNF. Los hombres del grupo de 20 a 44 años, los habitantes de áreas urbanas y los de mejor nivel socioeconómico (NSE) presentaron mayor prevalencia (p<0.05). Jalisco, Aguascalientes y Sonora registraron la mayor prevalencia y Guerrero, Michoacán y Oaxaca la menor. CONCLUSIONES: Los ATNF en México se concentran en hombres de edad productiva en zonas urbanas y se relacionan con el NSE individual y el desarrollo económico de cada estado.
OBJECTIVE: To determine non-fatal road traffic injuries (NFRTI) prevalence and its distribution in Mexico. MATERIAL AND METHODS: Data from ENSANUT Survey 2006 were used. Using simple random sampling, one adult, one adolescent and one child were selected in each household, constituting a final sample of 94 197 representing an N of 102 886 482 people. The dependent variable was the prevalence of road traffic injuries (RTI) during the 12 months prior to the survey. RESULTS: The general accident prevalence was 6.0 percent; 16.7 percent corresponded to NFRTI. Men in the 20 to 44 age group living in urban areas and with high socioeconomic status had a higher RTI prevalence (p<0.05). Jalisco, Aguascalientes and Sonora were states with the highest prevalence of RTI, while Guerrero, Michoacan and Oaxaca were those with the lowest. CONCLUSIONS: NFRTI are frequent in Mexico and they are concentrated among men in productive ages in urban areas; they are associated with socioeconomic status at the individual level and with the state's development at the population level.