Urquieta-Salomón José E, Villarreal Héctor J
National Institute of Public Health of Mexico, Centro de Investigación en Evaluación y Encuestas, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos 62508, México.
National Institute of Public Health of Mexico, Centro de Investigación en Evaluación y Encuestas, Av. Universidad 655, Col. Santa María Ahuacatitlán, Cuernavaca, Morelos 62508, México
Health Policy Plan. 2016 Feb;31(1):28-36. doi: 10.1093/heapol/czv015. Epub 2015 Mar 29.
To consolidate an effective and efficient universal health care coverage requires a deep understanding of the challenges faced by the health care system in providing services demanded by population in need. This study analyses the dynamics of health insurance coverage and effective access coverage to some health interventions in Mexico. It examines the evolution of inequalities and heterogeneous performance of the insurance subsystems incorporated under the Mexican health care system. Two types of coverage indicators were selected: health insurance and effective access to preventive health interventions intended for normative population. Data were drawn from National Health and Nutrition Surveys 2006 and 2012. The economic inequality was estimated using the Standardized Concentration Index by household per capita consumption expenditure as socioeconomic-status indicator. Approximately 75% of the population reported being covered by one of the existing insurance schemes, representing a huge step forward from 2006, when as much as 51.62% of the population had no health insurance. About 87% of this growth was attributable to the expansion of Non Contributory Health Insurance whereas 7% emanated from the Social Security subsystem. The results revealed that inequality in access to health insurance was virtually eradicated; however, traces of unequal access persisted in some subpopulations groups. Coverage indicators of effective access showed a slight improvement in the period analysed, but prenatal care and interventions to prevent chronic disease still presented a serious shortage. Furthermore, there was no evidence that inequities in coverage of these interventions have decreased in recent years. The results provided a mixed picture, generalizable to the system as a whole, expansion of insurance status represents one of the most remarkable advances that have not been accompanied by a significant improvement in effective access. In addition, existing inequalities are part of the most important challenges to be faced by the Mexican health system.
巩固有效且高效的全民医保覆盖需要深刻理解医疗保健系统在提供有需求人群所需服务时所面临的挑战。本研究分析了墨西哥医疗保险覆盖情况以及一些卫生干预措施的有效可及覆盖情况的动态变化。它考察了墨西哥医疗保健系统下纳入的保险子系统的不平等演变及异质性表现。选择了两类覆盖指标：医疗保险以及针对规范人群的预防性卫生干预措施的有效可及性。数据取自2006年和2012年的全国卫生与营养调查。使用标准化集中指数，以家庭人均消费支出作为社会经济地位指标来估计经济不平等。约75%的人口报告称被现有保险计划之一覆盖，这相较于2006年有了巨大进步，当时多达51.62%的人口没有医疗保险。这种增长中约87%归因于非缴费型医疗保险的扩大，而7%源自社会保障子系统。结果显示，获得医疗保险方面的不平等几乎消除；然而，在一些亚人群体中仍存在不平等可及的痕迹。有效可及性的覆盖指标在分析期内略有改善，但产前护理和慢性病预防干预措施仍严重短缺。此外，没有证据表明近年来这些干预措施覆盖方面的不平等有所减少。结果呈现出复杂的情况，对整个系统具有普遍适用性，保险覆盖范围的扩大是最显著的进展之一，但并未伴随着有效可及性的显著改善。此外，现有的不平等是墨西哥卫生系统面临的最重要挑战的一部分。
