[Capacity of the legal framework of public health institutions in Mexico to support their functional integration]. / Capacidad del marco jurídico de las instituciones públicas de salud de México para apoyar la integración funcional.

OBJECTIVE: Evaluate the capacity of the federal legal framework to govern financing of health institutions in the public sector through innovative schemes--otherwise known as functional integration--, enabling them to purchase and sell health services to and from other public providers as a strategy to improve their performance. MATERIALS AND METHODS: Based on indicators of normative alignment with respect to functional integration across public health provider and governance institutions, content analysis was undertaken of national health programs and relevant laws and guidelines for financial coordination. RESULTS: Significant progress was identified in the implementation of agreements for the coordination of public institutions. While the legal framework provides for a National Health System and a health sector, gaps and contradictions limit their scope. The General Register of Health is also moving forward, yet it lacks the necessary legal foundation to become a comprehensive tool for integration. The medical service exchange agreements are also moving forward based on tariffs and shared guidelines. However, there is a lack of incentives to promote the expansion of these agreements. CONCLUSIONS: It is recommended to update the legal framework for the coordination of the National Health System, ensuring a more harmonious and general focus to provide functional integration with the needed impulse.

Can better infrastructure and quality reduce hospital infant mortality rates in Mexico?

Preliminary evidence from hospital discharges hints enormous disparities in infant hospital mortality rates. At the same time, public health agencies acknowledge severe deficiencies and variations in the quality of medical services across public hospitals. Despite these concerns, there is limited evidence of the contribution of hospital infrastructure and quality in explaining variations in outcomes among those who have access to medical services provided at public hospitals. This paper provides evidence to address this question. We use probabilistic econometric methods to estimate the impact of material and human resources and hospital quality on the probability that an infant dies controlling for socioeconomic, maternal and reproductive risk factors. As a measure of quality, we calculate for the first time for Mexico patient safety indicators developed by the AHRQ. We find that the probability to die is affected by hospital infrastructure and by quality. In this last regard, having been treated in a hospital with the worse quality incidence doubles the probability to die. This paper also presents evidence on the contribution of other risk factors on perinatal mortality rates. The conclusions of this paper suggest that lower infant mortality rates can be reached by implementing a set of coherent public policy actions including an increase and reorganization of hospital infrastructure, quality improvement, and increasing demand for health by poor families.

Reforming the Mexican Health System to Achieve Effective Health Care Coverage.

Abstract-Despite important progress in financial protection with the last health reform implemented since 2003 with Seguro Popular, effective access to health care in Mexico has not yet been fully achieved. The vision of the present Mexican health administration, 2012-2018, is to transform the Mexican health care system so that it ensures equitable and effective access to quality health care, regardless of the labor or socioeconomic status of the person who seeks care. This article is an overview of how we at the Ministry of Health plan to fulfill this vision. It analyzes three challenges that the Mexican health system currently faces to achieve effective access to quality health care and proposes specific strategies to address them. The first step to fulfill that vision is to strengthen the stewardship role of the Ministry of Health, through instruments such as new legal frameworks and better information for more effective regulation and permanent monitoring and evaluation of the health care system's performance, with a focus on quality of health care. In the short term, better coordination between institutions should be achieved by ensuring that resources follow the patient where she receives care through the instruments suggested above and by guaranteeing that resources are used efficiently and in a transparent manner. In the long term, Mexico's health care system should adapt its infrastructure and human resources to deliver primary care services to effectively meet the increasing demands for chronic disease prevention and management.

Reforming "developing" health systems: Tanzania, Mexico, and the United States.

OBJECTIVE: Tanzania, Mexico, and the United States are at vastly different points on the economic development scale. Yet, their health systems can be classified as "developing": they do not live up to their potential, considering the resources available to them. The three, representing many others, share a common structural deficiency: a segregated health care system that cannot achieve its basic goals, the optimal health of its people, and their possible satisfaction with the system. Segregation follows and signifies first and foremost the lack of financial integration in the system that prevents it from serving its goals through the objectives of equity, cost containment and sustainability, efficient production of care and health, and choice. METHOD: The chapter contrasts the nature of the developing health care system with the common goals', objectives, and principles of the Emerging Paradigm (EP) in developed, integrated--yet decentralized--systems. In this context, the developing health care system is defined by its structural deficiencies, and reform proposals are outlined. FINDINGS: In spite of the vast differences amongst the three countries, their health care systems share strikingly similar features. At least 50% of their total funding sources are private. The systems comprise exclusive vertically integrated, yet segregated, "silos" that handle all systemic functions. These reflect and promote wide variations in health insurance coverage and levels of benefits--substantial portions of their populations are without adequate coverage altogether; a considerable lack of income protection from medical spending; an inability to formalize and follow a coherent health policy; a lack of financial discipline that threatens sustainability and overall efficiency; inefficient production of care and health; and an dissatisfied population. These features are often promoted by the state, using tax money, and donors. POLICY IMPLICATIONS: The situation can be rectified by (a) "centralizing"--at any level of development and resource availability--health system finance around a set package of core medical benefits that is made available to the entire population and (b) "decentralizing" consumption and provision of care. The first serves equity and cost containment and sustainability. The second supports efficiency and client satisfaction. ORIGINALITY/VALUE OF CHAPTER: The chapter views commonly discussed problems of the health care system--a lack of insurance coverage and income protection--as symptoms of a large problem: health system segregation.

Capacidad del marco jurídico de las instituciones públicas de salud de México para apoyar la integración funcional / Capacity of the legal framework of public health institutions in Mexico to support their functional integration

OBJETIVO: Evaluar la capacidad del marco legal federal para gobernar el financiamiento de las instituciones públicas de salud mediante esquemas innovadores que les permiten comprar y vender servicios de salud de y a otros proveedores públicos, como una estrategia para mejorar su desempeño. MATERIAL Y MÉTODOS: Con base en indicadores de alineamiento normativo respecto de la integración funcional entre instituciones proveedoras públicas y de gobernanza, se analizó el contenido de los programas nacionales de salud y de leyes y lineamientos oficiales pertinentes para la coordinación financiera. RESULTADOS: Se identificó un avance considerable en la implementación de convenios para la coordinación de las instituciones públicas. No obstante, el marco legal en apoyo al Sistema Nacional de Salud y al sector salud muestra deficiencias y contradicciones que limitan su alcance, mientras que el Padrón General de Salud carece del sustento legal necesario para convertirse en una herramienta de amplio beneficio para la integración. Si bien los convenios de intercambio de servicios están avanzando con base en tarifas y lineamientos compartidos, se carece de incentivos que promuevan su expansión. CONCLUSIONES: Es recomendable actualizar el marco legal para la coordinación del Sistema Nacional de Salud, procurando un enfoque más armónico y general que impulse la integración funcional.

OBJECTIVE: Evaluate the capacity of the federal legal framework to govern financing of health institutions in the public sector through innovative schemes -otherwise known as functional integration-, enabling them to purchase and sell health services to and from other public providers as a strategy to improve their performance. MATERIALS AND METHODS: Based on indicators of normative alignment with respect to functional integration across public health provider and governance institutions, content analysis was undertaken of national health programs and relevant laws and guidelines for financial coordination. RESULTS: Significant progress was identified in the implementation of agreements for the coordination of public institutions. While the legal framework provides for a National Health System and a health sector, gaps and contradictions limit their scope. The General Register of Health is also moving forward, yet it lacks the necessary legal foundation to become a comprehensive tool for integration. The medical service exchange agreements are also moving forward based on tariffs and shared guidelines. However, there is a lack of incentives to promote the expansion of these agreements. CONCLUSIONS: It is recommended to update the legal framework for the coordination of the National Health System, ensuring a more harmonious and general focus to provide functional integration with the needed impulse.