Abstract
This study aimed to describe the foundations for quality of care (QoC) in the Mexican public health sector and identify barriers to quality evaluation and improvement from the perspective of the QoC leaders of the main public health sector institutions: Ministry of Health (MoH), the Mexican Institute of Social Security (IMSS) and the Institute of Social Security of State Workers (ISSSTE). We administered a semi-structured online questionnaire that gathered information on foundations (governance, health workforce, platforms, tools and population), evaluation and improvement activities for QoC; 320 leaders from MoH, IMSS and ISSSTE participated. We used thematic content and descriptive analyses to analyse the data. We found that QoC foundations, evaluation and improvement activities pose essential challenges for the Mexican health sector. Governance for QoC is weakly aligned across MoH, IMSS and ISSSTE. Each institution follows its own agenda of evaluation and improvement programmes and has distinct QoC indicators and information systems. The institutions share similar barriers to strengthening QoC: poor organizational structure at a facility level, scarcity of financial resources, lack of training in QoC for executive/managerial staff and health professionals and limited public participation. In conclusion, a stronger legal framework and policy dialogue is needed to foster governance by the MoH, to define and align health sector-wide QoC policies, and to set common goals and articulate QoC improvement actions among institutions. Robust QoC organizational structure with designated staff and clarity on their responsibilities should be established at all levels of healthcare. Investment is necessary to fund formal and in-service QoC training programmes for health professionals and to reinforce quality evaluation and improvement activities and quality information systems. QoC evaluation results should be available to healthcare providers and the population. Active public participation in the design and implementation of improvement initiatives should be strengthened.
Highlights
In 2003, the government of Mexico established policies with the overt goal of attaining universal health coverage (UHC), including ensuring access to health care with adequate financial protection
Achievement of UHC and the broader Sustainable Development Goals (SDGs) for health is complicated by the organizational structure of the pluralistic health system, where employment status determines eligibility for public health insurance (Figure 1), benefit packages differ across insurances, and authority is distributed between the national and state levels
Some identified themselves as healthcare quality managers, mainly those working for the MoH local health secretariat (MoHLHS)
Summary
In 2003, the government of Mexico established policies with the overt goal of attaining universal health coverage (UHC), including ensuring access to health care with adequate financial protection. Army and navy workers have separate social security institutions Those without social security are affiliated with the non-contributory health insurance programme Seguro Popular (54 million affiliates) (Government of the United States of Mexico, 2016). Eight per cent of the population are privately insured and an additional 8% lack health insurance (Government of the United States of Mexico, 2016; Organisation for Economic CoOperation and Development, 2017). These public healthcare insurance plans provide different health benefits packages. The private market has many individual and corporate providers with distinct insurance plans
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