Department of Global Health and Population, Harvard TH Chan School of Public Health, 90 Smith Street, 3rd floor, Boston, MA, USA.
Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Cuidad de México, Av. Cuauhtémoc 330, Doctores, PC, Mexico.
Health Policy Plan. 2019 Nov 1;34(Supplement_2):ii67-ii76. doi: 10.1093/heapol/czz105.
Universal health coverage is a national priority in Mexico, with active efforts to expand public healthcare system access, increase financial protection and improve quality of care. We estimated effective coverage of multiple conditions within the Mexican Institute of Social Security (IMSS), which covers 62 million individuals. We identified routinely collected performance indicators at IMSS from 2016 related to use and quality of care for conditions avertable with high-quality healthcare; where candidate indicators were available, we quantified need for service from a population-representative survey and calculated effective coverage as proportion of individuals in need who experience potential health gains. We assessed subnational inequality across 32 states, and we weighted conditions by relative contribution to national disease burden to estimate composite effective coverage. Conditions accounting for 51% of healthcare-avertable disability-adjusted life years lost in Mexico could be assessed: antenatal care, delivery care, newborn care, childhood diarrhoea, cardiovascular disease and diabetes. Estimated effective coverage ranged from a low of 27% for childhood diarrhoea to a high of 74% for newborn care. Substantial inequality in effective coverage existed between states, particularly for maternal and child conditions. Overall effective coverage of these six conditions in IMSS was 49% in 2016. Gaps in use and quality of care must be addressed to ensure good health for all in Mexico. Despite extensive monitoring of health status and services in Mexico, currently available data are inadequate to the task of fully and routinely assessing health system effective coverage. Leaders at IMSS and similar healthcare institutions must be more purposeful in planning the assessment of population need, utilization of care and quality impacts of care to enable linkage of these data and disaggregation by location or population sub-group. Only then can complex health systems be fairly and fully evaluated.
全民健康覆盖是墨西哥的国家重点，墨西哥积极努力扩大公共医疗体系的覆盖范围，增加财务保障，并提高医疗质量。我们评估了墨西哥社会保障研究所（IMSS）覆盖的 6200 万人中多种疾病的有效覆盖率。我们从 2016 年 IMSS 的常规收集的绩效指标中确定了与高质量医疗保健可预防的疾病的利用和医疗质量相关的指标；在有候选指标的情况下，我们根据具有代表性的人口调查量化了服务需求，并将有效覆盖率计算为有潜在健康获益需求的个体比例。我们评估了 32 个州的次国家不平等情况，并根据对国家疾病负担的相对贡献对条件进行加权，以估计综合有效覆盖率。在墨西哥，51%的可通过医疗保健避免的残疾调整生命年损失的疾病可以评估：产前保健、分娩护理、新生儿护理、儿童腹泻、心血管疾病和糖尿病。估计的有效覆盖率从儿童腹泻的低 27%到新生儿护理的高 74%不等。各州之间在有效覆盖率方面存在很大差异，特别是在母婴健康状况方面。2016 年，IMSS 中这六种疾病的总体有效覆盖率为 49%。必须解决利用和医疗质量方面的差距，以确保墨西哥人人享有良好的健康。尽管墨西哥对健康状况和服务进行了广泛监测，但目前可用的数据不足以全面和定期评估卫生系统的有效覆盖率。IMSS 和类似医疗保健机构的领导人必须更有针对性地规划人口需求评估、医疗服务的利用和医疗质量的影响，以便将这些数据联系起来，并按地点或人口亚组进行分类。只有这样，才能公正和全面地评估复杂的卫生系统。
