Abstract
BackgroundThe Mexican health system segments access and right to healthcare according to worker position in the labour market. In this contribution we analyse how access and continuity of healthcare gets interrupted by employment turnover in the labour market, including its formal and informal sectors, as experienced by affiliates to the Mexican Institute of Social Security (IMSS) at national level, and of workers with type 2 diabetes (T2DM) in Mexico City.MethodsUsing data from the National Employment and Occupation Survey, 2014, and from IMSS electronic medical records for workers in Mexico City, we estimated annual employment turnover rates to measure the loss of healthcare access due to labour market dynamics. We fitted a binary logistic regression model to analyse the association between sociodemographic variables and employment turnover. Lastly we analysed job-related access to health care in relation to employment turnover events.ResultsAt national level, 38.3% of IMSS affiliates experienced employment turnover at least once, thus losing the right to access to healthcare. The turnover rate for T2DM patients was 22.5%. Employment turnover was more frequent at ages 20–39 (38.6% national level; 28% T2DM) and among the elderly (62.4% national level; 26% T2DM). At the national level, higher educational levels (upper-middle, OR = 0.761; upper, OR = 0.835) and income (5 minimum wages or more, OR = 0.726) were associated with lower turnover. Being single and younger were associated with higher turnover (OR = 1.413). T2DM patients aged 40–59 (OR = 0.655) and with 5 minimum wages or more (OR = 0.401) experienced less turnover. Being a T2DM male patient increased the risk of experiencing turnover (OR = 1.166). Up to 89% of workers losing IMSS affiliation and moving on to other jobs failed to gain job-related access to health services. Only 9% gained access to the federal workers social security institute (ISSSTE).ConclusionsTurnover across labour market sectors is frequently experienced by the workforce in Mexico, worsening among the elderly and the young, and affecting patients with chronic diseases. This situation needs to be prospectively addressed by health system policies that aim to expand the financial health protection during an employment turnover event.
Highlights
The Mexican health system segments access and right to healthcare according to worker position in the labour market
We focus on estimating the frequency and determinants of employment turnover of Mexican Institute of Social Security (IMSS)-affiliated workers (IAW) from affiliation to disaffiliation at the national level and by IMSS affiliates diagnosed with type 2 diabetes mellitus (T2DM) in Mexico City
Where: IAWt0 is any IAW with access to IMSS health services as a current job benefit at the beginning of the observed period; IAWt + 1is any IAW who experienced employment turnover at least once during the observed period; T is the number of times an individual experienced turnover between “t0” and “t + 1”; t0 is the beginning of the observation period and; t+ 1 is the end of observation period
Summary
The Mexican health system segments access and right to healthcare according to worker position in the labour market. The informal labour market is defined by the exclusion of access to such schemes and its reliance on out-of-pocket expenditure to access private services as well as on government support provided through social assistance programmes such as safety nets, cash transfers and voluntary contributory schemes to facilitate access to packages of limited health services. This segmentation has been considered a problem in Mexico because it excludes large population groups from social security rights and restricts access to government-subsidised healthcare, in a context where turnover across formal and informal labour market segments can occur [5]. Participating in the formal or informal labour markets can be considered a social determinant of health since access to health services and related health outcomes depend on the conditions of employment [6,7,8,9]
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