The impact of primary health care and specialist physician supply on amenable mortality in Mexico (2000–2015): Panel data analysis using system-Generalized Method of Moments

Zlatko Nikoloski,Sarah Albala,Andres Madriz Montero,Elias Mossialos

doi:10.1016/j.socscimed.2021.113937

Zlatko Nikoloski, Sarah Albala + Show 2 more

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https://doi.org/10.1016/j.socscimed.2021.113937

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Abstract

The study had a three-fold objective: (i) to estimate the amenable mortality rates and trends at a national and state level between 2000 and 2015 in Mexico; (ii) to estimate the contribution and trends of various causes of death to overall amenable mortality; and (iii) to determine the association between health system inputs and amenable mortality for the period 2000–2015. We used a panel dataset for the period 2000–2015. The following health care inputs were used in the analysis: density of general practitioners, specialists and nurses, as well as density of hospital beds. We find that amenable mortality fell from 136 per 100,000 in 2000, to 124.1 per 100,000 in 2015 nationally, with significant heterogeneity in the trends across states. Mortality due to infectious diseases, diseases of childhood, and cardiovascular diseases decreased, while deaths due to other non-communicable diseases, such as diabetes, increased. There was a significant negative association between the density of general practitioners and specialist physicians, and amenable mortality. Our results indicate that reducing the burden of non-communicable diseases must be a health system priority. Improvements in primary health care could lead to improved disease detection and earlier diagnosis which could further reduce amenable mortality in Mexico.

Highlights

It has been more than 15 years since the introduction of Seguro Popular (SP), a public health insurance scheme for uninsured people in Mexico
This study assessed the trends in amenable mortality in Mexico over the period 2000–2015, at national and state levels, and assessed the determinants of these trends
We found a significant increase in amenable mortality due to diabetes during a period when the prevalence of diabetes was increasing

Summary

Introduction

It has been more than 15 years since the introduction of Seguro Popular (SP), a public health insurance scheme for uninsured people in Mexico. The introduction of SP has been associated with improved ac cess to health care. According to the National Council for the Evaluation of Social Development Policy (CONEVAL), 57.3 million individuals ac cess affordable health care through SP (CONEVAL, 2014) the majority of whom belong to the four poorest deciles of the population (Knaul et al, 2005). The SP has no restrictions based on current health status or pre-existing illness, and no co-payments according to type of health care. Contributions to SP are based on households’ ability to pay: households classified in the first two income deciles are exempt from any annual payment, while those belonging to higher deciles make an annual contribution (Knaul and Frenk, 2005). The roll-out of SP was accompanied by progress in key health indicators such as maternal and infant mortality and reduced deaths from communicable and nutrition-related illnesses (Agudelo-Botero and Davila-Cervantes, 2014)

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