Unidad de Investigación Epidemiológica y en Servicios de Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Unidad de Investigación Epidemiológica y en Servicios de Salud, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Arch Med Res. 2024 Jul;55(5):103011. doi: 10.1016/j.arcmed.2024.103011. Epub 2024 Jun 14.
To evaluate the progress of the Mexican Institute of Social Security Recovery Policy (IMSS-RP) in addressing the decline in essential health services caused by the COVID-19 pandemic.
We analyzed eleven indicators of essential health services from 35 IMSS state delegations. The assessment included ambulatory and hospital care indicators such as breast and cervical cancer screening, family medicine, dental and specialty visits, diabetes and hypertension visits and health outcomes, deliveries, and elective surgeries. We analyzed the period before (January 2018-March 2021) and during (April 2021-June 2023) the implementation of the IMSS-RP. Statistical analysis to determine the association of the policy with service indicators and the change in their trends included an interrupted time series analysis and Poisson Generalized Estimating Equation models.
The volume of services showed substantial declines during the first year of the COVID-19 pandemic, reaching between 11 and 81% of pre-pandemic levels. All services increased significantly during the first 27 months of the IMSS-RP implementation; specialty visits, cervical and breast cancer screening, and diabetes control exceeded pre-pandemic levels (103%,112%,103%, and 138%, respectively). However, only deliveries and the percentage of patients with controlled diabetes and hypertension showed a stable increase following the IMSS-RP implementation, whereas the remaining services showed an initial increase but began to decrease over time.
After 27 months of implementation, IMSS-RP achieved progress in increasing the volume of essential health services and improving chronic disease control. However, declining trends in several services signal the need to focalize the policy.
评估墨西哥社会保障金复苏政策研究所（IMSS-RP）在应对 COVID-19 大流行导致基本卫生服务下降方面的进展。
我们分析了 35 个 IMSS 州代表处的 11 项基本卫生服务指标。评估包括门诊和住院服务指标，如乳腺癌和宫颈癌筛查、家庭医学、牙科和专科就诊、糖尿病和高血压就诊以及健康结果、分娩和择期手术。我们分析了实施 IMSS-RP 之前（2018 年 1 月至 2021 年 3 月）和期间（2021 年 4 月至 2023 年 6 月）的情况。包括中断时间序列分析和泊松广义估计方程模型的统计分析用于确定政策与服务指标的关联及其趋势变化。
在 COVID-19 大流行的第一年，服务量大幅下降，达到了大流行前水平的 11%至 81%。在 IMSS-RP 实施的头 27 个月，所有服务都显著增加；专科就诊、宫颈癌和乳腺癌筛查以及糖尿病控制都超过了大流行前的水平（分别为 103%、112%、103%和 138%）。然而，只有分娩和控制糖尿病和高血压的患者比例在实施 IMSS-RP 后显示出稳定增加，而其余服务则显示出初始增加但随着时间的推移开始下降。
在实施 27 个月后，IMSS-RP 在增加基本卫生服务量和改善慢性病控制方面取得了进展。然而，几项服务的下降趋势表明需要集中精力实施该政策。
