Rivera-Hernandez Maricruz, Rahman Momotazur, Mor Vincent, Galarraga Omar
Department of Health Services, Policy and Practice, Brown University, Providence, RI.
Health Serv Res. 2016 Aug;51(4):1323-46. doi: 10.1111/1475-6773.12404.
To examine the impact of Seguro Popular (Mexican social health insurance for the poor; SP) on diabetes and hypertension care, intermediate process indicators for older adults (>50 years): pharmacological treatment, blood glucose tests, the use of complementary and alternative medicine (CAM), and adherence to their nutrition and exercise program. (CAM was defined as products or practices that were not part of the medical standard of care.)
DATA SOURCES/STUDY SETTING: Repeated cross-sectional surveys from Encuesta Nacional de Salud y Nutrición (Mexican Health and Nutrition Survey, ENSANUT), a nationally representative health and nutrition survey sampling N = 45,294 older adults in 2000, N = 45,241 older adults in 2005-2006, and N = 46,277 older adults in 2011-2012.
Fixed-effects instrumental variable (FE-IV) repeated cross-sectional at the individual level with municipality fixed-effects estimation was performed.
We found a marginally significant effect of SP on the use of insulin and oral agents (40 percentage points). Contrary to that expected, no other significant differences were found for diabetes or hypertension treatment and care indicators.
Social health insurance for the poor improved some but not all health care process indicators among diabetic and hypertensive older people in Mexico.
研究大众保险（墨西哥针对贫困人口的社会医疗保险；SP）对糖尿病和高血压护理的影响，以及针对老年人（>50岁）的中间过程指标：药物治疗、血糖检测、补充和替代医学（CAM）的使用，以及对其营养和运动计划的依从性。（CAM被定义为不属于医疗标准护理一部分的产品或做法。）
数据来源/研究背景：来自全国健康与营养调查（Encuesta Nacional de Salud y Nutrición，墨西哥健康与营养调查，ENSANUT）的重复横断面调查，这是一项具有全国代表性的健康与营养调查，2000年抽样45294名老年人，2005 - 2006年抽样45241名老年人，2011 - 2012年抽样46277名老年人。
在个体层面进行固定效应工具变量（FE-IV）重复横断面研究，并采用市政固定效应估计。
我们发现SP对胰岛素和口服药物的使用有微弱显著影响（40个百分点）。与预期相反，在糖尿病或高血压治疗及护理指标方面未发现其他显著差异。
墨西哥针对贫困人口的社会医疗保险改善了糖尿病和高血压老年患者部分而非全部的医疗护理过程指标。
