National Center for Health Technology Excellence, Ministry of Health, México.
Independent researcher, México.
Int J Health Plann Manage. 2019 Apr;34(2):619-635. doi: 10.1002/hpm.2722. Epub 2019 Jan 7.
To assess the relationship between government expenditure on maternal health (GE) and maternal mortality (MM) in Mexican poor population between 2000 and 2015 in the 2457 Mexican municipalities.
Using administrative data, we performed the analysis in three stages: First, we tested the presence of selection bias in MM. Next, we assessed the presence of spatial dependence in the incidence and severity of MM. Finally, we estimated a spatial error model considering the correction of estimates for the spatial dependence and selection bias assessed before.
MM and GE were not randomly distributed throughout the Mexican territory; the most socially vulnerable municipalities exhibited the highest levels of MM severity but the lowest levels of GE and available human and physical resources for maternal health; the incidence of MM was independent of GE; elasticity of GE-severity in MM was -4% (P < 0.01).
Resource allocation for maternal health must move towards a more comprehensive vision, and efforts to achieve an effective delivery of universal health services must improve, particularly regarding the most vulnerable municipalities.
评估 2000 年至 2015 年期间，2457 个墨西哥城市中，政府对孕产妇保健（GE）支出与孕产妇死亡率（MM）之间的关系在墨西哥贫困人群中的关系。
利用行政数据，我们分三个阶段进行分析：首先，我们测试了 MM 中是否存在选择偏差。其次，评估了 MM 的发生率和严重程度的空间相关性。最后，考虑到之前评估的空间相关性和选择偏差的校正，我们估计了一个空间误差模型。
MM 和 GE 在墨西哥领土上的分布并非随机；社会最脆弱的城市表现出最高水平的 MM 严重程度，但 GE 水平和孕产妇保健的人力物力资源最低；MM 的发病率与 GE 无关；MM 中 GE-严重程度的弹性为-4%（P<0.01）。
孕产妇保健资源的分配必须朝着更全面的方向发展，努力实现有效的全民健康服务，特别是针对最脆弱的城市。
