Centre for Research on Evaluation and Surveys, National Institute of Public Health (INSP-Instituto Nacional de Salud Pública), Cuernavaca, Mexico.
Centre for Research on Population Health, National Institute of Public Health (INSP-Instituto Nacional de Salud Pública), Cuernavaca, Mexico.
JCO Glob Oncol. 2024 May;10:e2300060. doi: 10.1200/GO.23.00060.
Cost containment and efficiency in the provision of health care are primary concerns for health systems that aim to provide affordable, high-quality care. Between 2005 and 2015, Seguro Poplar's Fund against Catastrophic Expenditures (FPGC) funded ALL treatment in Mexico. Before January 1, 2011, FPGC reimbursed a fixed amount per patient according to risk. In 2011, the per capita reimbursement method changed to fee for service. We used this natural experiment to estimate the impact of the reimbursement policy change on average expenditure and quality of care for ALL treatment in Mexico.
We used nationwide reimbursement data from the Seguro Poplar's FPGC from 2005 to 2015. We created a patient cohort to assess 3-year survival and estimate the average reimbursement before and after the fee-for-service policy. We examined survival and expenditure impacts, controlling for patients' and providers' characteristics, including sex, risk (standard and high), the volume of patients served, type of institution (federally funded other), and level of care. To quantify the impact, we used a regression discontinuity approach.
The average reimbursement for standard-risk patients in the 3-year survival cohort was $16,512 US dollars (USD; 95% CI, 16,042 to 17,032) before 2011 and $10,205 USD (95% CI, 4,659 to 12,541) under the fee-for-service reimbursement scheme after 2011. The average annual reimbursement per patient decreased by 136% among high-risk patients. The reduction was also significant for the standard-risk cohort, although the magnitude was substantially smaller (34%).
As Mexico's government is currently restructuring the health system, our study provides evidence of the efficiency and effectiveness of the funding mechanism in the Mexican context. It also serves as a proof of concept for using administrative data to evaluate economic performance and quality of care of publicly funded health programs.
在旨在提供负担得起的高质量医疗保健的医疗体系中，控制成本和提高效率是首要关注点。在 2005 年至 2015 年间，Seguro Popular 的灾难性支出基金（FPGC）为墨西哥的所有治疗提供资金。在 2011 年 1 月 1 日之前，FPGC 根据风险按固定金额向每位患者报销。2011 年，人均报销方法改为按服务收费。我们利用这一自然实验来估计报销政策变化对墨西哥所有治疗的平均支出和医疗质量的影响。
我们使用了 2005 年至 2015 年期间来自 Seguro Popular 的 FPGC 的全国性报销数据。我们创建了一个患者队列，以评估 3 年生存率，并估计服务收费政策前后的平均报销额。我们检查了生存率和支出的影响，同时控制了患者和提供者的特征，包括性别、风险（标准和高）、服务患者的数量、机构类型（联邦资助的其他）和护理水平。为了量化影响，我们使用了回归不连续性方法。
在 3 年生存率队列中，标准风险患者的平均报销额在 2011 年之前为 16512 美元（95%置信区间为 16042 至 17032 美元），在 2011 年之后的服务收费报销方案下为 10205 美元（95%置信区间为 4659 至 12541 美元）。高风险患者的人均年报销额下降了 136%。标准风险队列的降幅也很显著，尽管幅度要小得多（34%）。
随着墨西哥政府目前正在重组医疗体系，我们的研究为墨西哥背景下的资金机制的效率和效果提供了证据。它还为使用行政数据评估公共资助卫生计划的经济绩效和医疗质量提供了一个概念验证。
