National Institute of Public Health, Cuernavaca, Morelos, Mexico.
University of California, Berkeley, California, United States of America.
PLoS One. 2018 Jul 2;13(7):e0199543. doi: 10.1371/journal.pone.0199543. eCollection 2018.
The purpose of this study is to analyze the alignment of supply and demand for antenatal care (ANC) in Mexico based on the definition of access provided by Donabedian: the "degree of adjustment" between resources and needs. Alignment was studied in the teenage and adult population of Mexico that lacked conventional social security between 2008 and 2015, a period of expanding financial resources for health and public health insurance coverage. Spatial econometric methods were used to analyze data from the Ministry of Health on the supply and demand for ANC in 2,314 municipalities (94% of all municipalities in Mexico). During this period, the relative weight of ANC demand among adolescents increased 37% while the production of antenatal consultations for adolescent and adult women remained unchanged. Bivariate spatial analyses of correlation between supply and demand for ANC services yielded a minimal spatial correlation, or lack of territorial correspondence, between supply and demand among women in both age groups. Spatial econometric analysis confirmed a non-significant association between supply and demand for ANC services. Our findings suggest the existence of misalignment between supply and demand for these services. This requires a reassessment of the management and delivery of ANC services at the local level in order to increase effective coverage and improve the overall performance of the health system.
本研究旨在基于 Donabedian 提出的可及性定义，即“资源与需求的调整程度”，分析墨西哥产前护理（ANC）供需之间的一致性。研究对象为 2008 年至 2015 年间缺乏传统社会保险的墨西哥青少年和成年人群体，这一时期医疗保健资金和公共医疗保险覆盖范围不断扩大。本研究采用空间计量经济学方法，分析了卫生部提供的关于 2314 个城市（墨西哥所有城市的 94%）的 ANC 供应和需求的数据。在此期间，青少年对 ANC 的需求相对权重增加了 37%，而青少年和成年女性的产前咨询量保持不变。对 ANC 服务供需之间的相关性进行二元空间分析，发现两个年龄组的女性之间的供应和需求之间存在最小的空间相关性，或缺乏地域对应关系。空间计量经济学分析证实 ANC 服务的供应和需求之间没有显著关联。我们的研究结果表明，这些服务的供应和需求之间存在错位。这需要重新评估地方一级 ANC 服务的管理和提供，以提高有效覆盖范围并改善卫生系统的整体绩效。
