School of Public Health of Mexico at the National Institute of Public Health of Mexico, Av. Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico.
Center for Health System Research, National Institute of Public Health of Mexico, Av. Universidad 655, Santa María Ahuacatitlán, 62100 Cuernavaca, Morelos, Mexico.
Health Policy Plan. 2020 Oct 1;35(8):889-899. doi: 10.1093/heapol/czaa055.
'Social efficiency' (SE) denotes the capacity of health systems to ensure equitable access to quality health services at no financial risk to users. Mexico and other low- and middle-income countries have rarely studied the performance of their health systems from an SE perspective. We propose a metric for assessing SE in the production of maternal health services in the public sector among populations without social security, analysing contextual correlates of the demand for these services. Analysis was based on administrative data collected from the 243 health jurisdictions (HJs) in Mexico for the period 2008-15. We defined production inputs as the availability of physical and human resources and social product as the unweighted sum of social sub-products, including an equitable distribution of maternal health resources, the provision of quality maternal health care and financial protection for users. We described the SE scores, the main contextual characteristics as well as those related to the demand for maternal health services. We then performed a variance decomposition analysis of the SE score by component and estimated the SE territorial concentration patterns. Finally, we identified the structural characteristics modelling SE by means of a spatial autoregressive panel data model with fixed effects by year. The SE score rose from 57.7% in 2008 to 71.9% in 2015 (P < 0.01), with its quality component accounting for the largest proportion of variance (30%). SE peaked in HJs with low social marginalization and rurality, and with service demand characterized by low parity and older populations. Different SE levels demonstrated territorial concentration patterns. Analysing SE as a metric for health system performance offers elements that contribute to the achievement of UHC as well as to the design and implementation of effective maternal health interventions intended particularly for the most socially vulnerable sectors of the population.
“社会效益”（SE）是指卫生系统确保在不使用户面临财务风险的情况下公平获得优质卫生服务的能力。墨西哥和其他中低收入国家很少从 SE 角度研究其卫生系统的绩效。我们提出了一种衡量公共部门中无社会保障人群的妇幼保健服务生产的 SE 的指标，分析了这些服务需求的背景关联。分析基于 2008-15 年期间从墨西哥 243 个卫生管辖区（HJ）收集的行政数据。我们将生产投入定义为物质和人力资源的可用性，将社会产品定义为社会子产品的未加权总和，包括公平分配妇幼保健资源、提供优质妇幼保健服务以及为用户提供财务保护。我们描述了 SE 得分、主要背景特征以及与妇幼保健服务需求相关的特征。然后，我们按组成部分对 SE 得分进行方差分解分析，并估计了 SE 的地域集中模式。最后，我们通过具有固定效应的空间自回归面板数据模型确定了建模 SE 的结构特征。SE 得分从 2008 年的 57.7%上升到 2015 年的 71.9%（P<0.01），其中质量组成部分占方差的最大比例（30%）。SE 在社会边缘化程度和农村程度低、服务需求特征为低生育和老年人口的 HJ 中达到峰值。不同的 SE 水平表现出地域集中模式。将 SE 作为卫生系统绩效的衡量标准进行分析，提供了有助于实现全民健康覆盖以及设计和实施针对人口中最弱势群体的有效妇幼保健干预措施的要素。
