Serván-Mori Edson, Contreras-Loya David, Gomez-Dantés Octavio, Nigenda Gustavo, Sosa-Rubí Sandra G, Lozano Rafael
National Institute of Public Health, Cuernavaca, Mexico.
School of Public Health, University of California, Berkeley.
Health Policy Plan. 2017 Jun 1;32(5):625-633. doi: 10.1093/heapol/czw161.
This study provides evidence for those working in the maternal health metrics and health system performance fields, as well as those interested in achieving universal and effective health care coverage. Based on the perspective of continuity of health care and applying quasi-experimental methods to analyse the cross-sectional 2009 National Demographic Dynamics Survey (n = 14 414 women), we estimated the middle-term effects of Mexico's new public health insurance scheme, Seguro Popular de Salud (SPS) (vs women without health insurance) on seven indicators related to maternal health care (according to official guidelines): (a) access to skilled antenatal care (ANC); (b) timely ANC; (c) frequent ANC; (d) adequate content of ANC; (e) institutional delivery; (f) postnatal consultation and (g) access to standardized comprehensive antenatal and postnatal care (or the intersection of the seven process indicators). Our results show that 94% of all pregnancies were attended by trained health personnel. However, comprehensive access to ANC declines steeply in both groups as we move along the maternal healthcare continuum. The percentage of institutional deliveries providing timely, frequent and adequate content of ANC reached 70% among SPS women (vs 64.7% in the uninsured), and only 57.4% of SPS-affiliated women received standardized comprehensive care (vs 53.7% in the uninsured group). In Mexico, access to comprehensive antenatal and postnatal care as defined by Mexican guidelines (in accordance to WHO recommendations) is far from optimal. Even though a positive influence of SPS on maternal care was documented, important challenges still remain. Our results identified key bottlenecks of the maternal healthcare continuum that should be addressed by policy makers through a combination of supply side interventions and interventions directed to social determinants of access to health care.
本研究为从事孕产妇健康指标和卫生系统绩效领域工作的人员，以及那些致力于实现全民有效医疗覆盖的人士提供了证据。基于医疗保健连续性的视角，并运用准实验方法分析2009年全国人口动态横断面调查（n = 14414名女性）的数据，我们估算了墨西哥新的公共医疗保险计划“大众健康保险”（SPS）（与未参保女性相比）对七个与孕产妇保健相关指标（根据官方指南）的中期影响：（a）获得熟练的产前护理（ANC）；（b）及时的ANC；（c）频繁的ANC；（d）ANC的充足内容；（e）机构分娩；（f）产后咨询；以及（g）获得标准化的综合产前和产后护理（或七个过程指标的交集）。我们的结果显示，94%的妊娠有经过培训的卫生人员参与。然而，随着我们沿着孕产妇保健连续过程推进，两组中获得全面ANC的比例均急剧下降。在SPS参保女性中，提供及时、频繁且内容充足的ANC的机构分娩比例达到70%（未参保女性为64.7%），且只有57.4%的SPS参保女性获得了标准化的综合护理（未参保组为53.7%）。在墨西哥，按照墨西哥指南（根据世卫组织建议）定义的获得全面产前和产后护理的情况远未达到最佳状态。尽管记录了SPS对孕产妇护理的积极影响，但重要挑战依然存在。我们的结果确定了孕产妇保健连续过程中的关键瓶颈，政策制定者应通过供应方干预措施以及针对医疗保健可及性社会决定因素的干预措施相结合来加以解决。
