Mexican Health Care System Research Articles

Abstract IA23: Steps to address the profound disparity in access to genetic cancer risk assessment in Mexico: Documenting hereditary breast and ovarian cancer and the beginning of a prevention program

Abstract IA23: Steps to address the profound disparity in access to genetic cancer risk assessment in Mexico: Documenting hereditary breast and ovarian cancer and the beginning of a prevention program

Accounting for Blame: The Paradoxical Consequences of Measuring Maternal Death in Mexico: Table 1.

In Mexico, the measurement of maternal death has demonstrated the extent to which the risk to women’s lives is determined by their class, location, and ethnicity. In this paper, I examine how the Mexican federal government has implemented measurement and monitoring regimes to track and respond to maternal deaths. Drawing on field research and interviews conducted at various times between 2004 and 2010, I consider some of the contradictory knowledge and governance effects that this turn to measurement has generated in the Mexican health-care system. Measurement and monitoring regimes, I argue, have given maternal health advocates the evidence to argue that it is failings within the health-care system which have made high levels of mortality so intractable. At the same time, measuring mortality has rendered broader aspects of sexual and reproductive rights less visible, while also generating a politics of responsibility and culpability. I trace in this paper a tendency by some health-care professionals to resist what they see as the punitive nature of maternal health monitoring regimes, by either ‘gaming’ the numbers, and/or shifting responsibility other, usually more vulnerable, populations. This analysis highlights the importance of attending to the context in which measurement regimes are introduced. In the context of a deeply flawed system, measurement regimes will generate tensions around responsibility which cannot easily be resolved, and may be resisted by those on whom the regime depends for its reliability.

Cost-Effectiveness of Canagliflozin versus Sitagliptin as Add-on to Metformin in Patients with Type 2 Diabetes Mellitus in Mexico

ObjectiveTo assess the cost-effectiveness of canagliflozin versus sitagliptin for the treatment of type 2 diabetes mellitus (T2DM) as an add-on to metformin in Mexico. MethodsA validated model (Economic and Health Outcomes [ECHO]-T2DM) was used to estimate the cost-effectiveness of canagliflozin 300 or 100 mg versus sitagliptin 100 mg in patients with T2DM inadequately controlled on metformin monotherapy. Data from a head-to-head, phase III clinical trial, including patients’ baseline demographic characteristics, biomarker values, and treatment effects, were used to simulate outcomes and resource use over 20 years from the perspective of the Mexican health care system. Costs of complications and adverse events were tailored to the Mexican setting and discounted at 5%. Cost-effectiveness was assessed using willingness-to-pay thresholds equivalent to 1 times the gross domestic product per capita (locally perceived to be “very cost-effective”) and 3 times the gross domestic product per capita (locally perceived to be “cost-effective”) on the basis of recommendations of the Mexican government and the World Health Organization. ResultsOwing primarily to better glycated hemoglobin (HbA1c), body weight, and systolic blood pressure values, canagliflozin 300 and 100 mg were associated with an incremental benefit of 0.16 and 0.06 quality-adjusted life-years (QALYs) versus sitagliptin 100 mg, respectively, over 20 years. The mean differences in cost for canagliflozin 300 and 100 mg versus sitagliptin 100 mg were Mexican pesos (MXP) 1797 (US $134) and MXP 7262 (US $540), respectively, resulting in a cost per QALY gained of MXP 11,210 (US $834) and MXP 128,883 (US $9590), respectively. Both of these cost-effectiveness ratios are below the very cost-effective willingness-to-pay threshold in Mexico. The general finding that canagliflozin is cost-effective versus sitagliptin in Mexico was supported by sensitivity analyses. ConclusionIn Mexico, both doses of canagliflozin are likely to be cost-effective versus sitagliptin in patients with T2DM who have inadequate glucose control on metformin, primarily because of better biomarker control and higher QALYs.

Reforming the Mexican Health System to Achieve Effective Health Care Coverage

—Despite important progress in financial protection with the last health reform implemented since 2003 with Seguro Popular, effective access to health care in Mexico has not yet been fully achieved. The vision of the present Mexican health administration, 2012–2018, is to transform the Mexican health care system so that it ensures equitable and effective access to quality health care, regardless of the labor or socioeconomic status of the person who seeks care. This article is an overview of how we at the Ministry of Health plan to fulfill this vision. It analyzes three challenges that the Mexican health system currently faces to achieve effective access to quality health care and proposes specific strategies to address them. The first step to fulfill that vision is to strengthen the stewardship role of the Ministry of Health, through instruments such as new legal frameworks and better information for more effective regulation and permanent monitoring and evaluation of the health care system's performance, with a focus on quality of health care. In the short term, better coordination between institutions should be achieved by ensuring that resources follow the patient where she receives care through the instruments suggested above and by guaranteeing that resources are used efficiently and in a transparent manner. In the long term, Mexico's health care system should adapt its infrastructure and human resources to deliver primary care services to effectively meet the increasing demands for chronic disease prevention and management.

Evolution of health coverage in Mexico: evidence of progress and challenges in the Mexican health system.

To consolidate an effective and efficient universal health care coverage requires a deep understanding of the challenges faced by the health care system in providing services demanded by population in need. This study analyses the dynamics of health insurance coverage and effective access coverage to some health interventions in Mexico. It examines the evolution of inequalities and heterogeneous performance of the insurance subsystems incorporated under the Mexican health care system. Two types of coverage indicators were selected: health insurance and effective access to preventive health interventions intended for normative population. Data were drawn from National Health and Nutrition Surveys 2006 and 2012. The economic inequality was estimated using the Standardized Concentration Index by household per capita consumption expenditure as socioeconomic-status indicator. Approximately 75% of the population reported being covered by one of the existing insurance schemes, representing a huge step forward from 2006, when as much as 51.62% of the population had no health insurance. About 87% of this growth was attributable to the expansion of Non Contributory Health Insurance whereas 7% emanated from the Social Security subsystem. The results revealed that inequality in access to health insurance was virtually eradicated; however, traces of unequal access persisted in some subpopulations groups. Coverage indicators of effective access showed a slight improvement in the period analysed, but prenatal care and interventions to prevent chronic disease still presented a serious shortage. Furthermore, there was no evidence that inequities in coverage of these interventions have decreased in recent years. The results provided a mixed picture, generalizable to the system as a whole, expansion of insurance status represents one of the most remarkable advances that have not been accompanied by a significant improvement in effective access. In addition, existing inequalities are part of the most important challenges to be faced by the Mexican health system.

PSS23 - Cost-Effectiveness of Ranibizumab on Patients With Diffuse Diabetic Macular Edema Within the Public Mexican Health Care System

PSS23 - Cost-Effectiveness of Ranibizumab on Patients With Diffuse Diabetic Macular Edema Within the Public Mexican Health Care System

Cost-Effectiveness Of Mycophelonate Sodium On Patients With Renal Transplant At The Public Mexican Health Care System.

Cost-Effectiveness Of Mycophelonate Sodium On Patients With Renal Transplant At The Public Mexican Health Care System.

CASALUD: an innovative health-care system to control and prevent non-communicable diseases in Mexico

Mexico and other Latin American countries are currently facing a dramatic increase in the number of adults suffering from non-communicable diseases (NCDs) such as diabetes, cardiovascular disease (CVD) and chronic kidney disease (CKD), which require prolonged, continuous care. This epidemiological shift has created new challenges for health-care systems. Both the World Health Organization (WHO) and the United Nations (UN) have recognised the growing human and economic costs of NCDs and outlined an action plan, recognising that NCDs are preventable, often with common preventable risk factors linked to risky health behaviours. In line with international best practices, Mexico has applied a number of approaches to tackle these diseases. However, challenges remain for the Mexican health-care system, and in planning a strategy for combating and preventing NCDs, it must consider how best to integrate these strategies with existing health-care infrastructure. Shifting the paradigm of care in Mexico from a curative, passive approach to a preventive, proactive model will require an innovative and replicable system that guarantees availability of medicines and services, strengthens human capital through ongoing professional education, expands early and continuous access to care through proactive prevention strategies and incorporates technological innovations in order to do so. Here, we describe CASALUD: an innovative model in health-care that leverages international best practices and uses innovative technology to deliver NCD care, control and prevention. In addition, we describe the lessons learned from the initial implementation of the model for its effective use in Mexico, as well as the plans for wider implementation throughout the country, in partnership with the Mexican Ministry of Health.

Disability-adjusted life-years (DALYs) for diabetes in Mexico in 2005: a cross-sectional burden of disease analysis

BackgroundDiabetes is one of the leading causes of morbidity and mortality in Mexico and its prevalence has been rising since the end of the last century. The aim of this study was to estimate, for 2005, the share of burden due to this disease in the Instituto Mexicano del Seguro Social—the major social security institution in Mexico, which covers nearly half of Mexico's population. MethodsDisability-adjusted life-years (DALYs) were calculated by the sum of the estimated years of life lost (YLLs) and years lived with disability (YLDs) due to diabetes. The International Statistical Classification of Disease and Related Health Problems 10th Revision was used, and we included the E10–E14 codes related to diabetes mellitus. YLLs were calculated from age–sex–time-specific estimates of mortality by diabetes. YLDs were calculated by age and sex, and prevalence of diabetes and its disabling sequelae such as retinopathy, amputation, diabetic foot, and neuropathy. FindingsIn 2005, diabetes contributed 787 397 DALYs, 9·21% (95% CI 9·19–9·23) of total DALYs in Mexico, an increase from 7·31% (7·28–7·33) estimated in 1995. 5·83% (95% CI 5·79–5·89) of DALYs due to diabetes were attributed to retinopathy, 2·62% (2·58–2·65) to amputation, and 0·94% (0·92–0·96) to diabetic foot and neuropathy. While in adults aged between 25 and 44 years of age 64·29% (95% CI 64·00–64·60) of DALYs were due to YLDs, this proportion was 18·70% (18·50–18·90) in adults aged 45–59 years and only 6·47% (6·39–6·54) in those aged 60 years and older. 55·52% (95% CI 55·40–55·60) of the population affected with DALYs due to diabetes were female. InterpretationIn recent years, diabetes has been challenging the Mexican health-care system due to its high mortality rate and its high costs of care. In spite of the burden due to mortality, there is also a high burden due to YLDs, mainly among the younger age groups. Some neglected microvascular complications of diabetes, such as retinopathy, neuropathy, and diabetic foot, have contributed considerably to DALYs in Mexico. FundingMexican Social Security Institute (Grant No. 2005-785-154).

PCN147 - Non-Traditional Schemes Approach For Public Market Access Of End-Of-Life Treatments In Mexican Health Care System

PCN147 - Non-Traditional Schemes Approach For Public Market Access Of End-Of-Life Treatments In Mexican Health Care System

PUK2 - Cost analysis of kidney trasplantation with different tratment alternatives at different stages within the mexican public health care system

PUK2 - Cost analysis of kidney trasplantation with different tratment alternatives at different stages within the mexican public health care system

Mobile Midwesterners: The Impact of Migration on Aging, Health, and Community

As the population in the US ages, there is increasing need to study aging and its relationship to quality of life, health, and community. Quality of life is closely correlated with belonging to a community. Unfortunately, as seniors age there is a propensity for them to become increasingly isolated as their mobility decreases and their friends and family members die or move away. As a result, some seniors in the Midwest have begun to migrate to RV parks in the Lower Rio Grande Valley (“LRGV”) in south Texas that function as temporary retirement communities for the winter. While there, they reconnect with friends and family members and engage in a variety of social, civic, and exercise related activities. Further, they participate in a variety of health seeking behaviors such as health screenings, trading medications, and using the Mexican health care system. This article explores these practices and discusses how Winter Texans choose the LRGV, how new members become integrated into RV parks, and how life in the parks impacts health and access to health care services. It also highlights the impact that seasonal migration has on community formation, health seeking behaviors, and the diversity of retirement communities.

PCN33 Indirect Analysis of the Efficacy and Safety of Pemetrexed/Cisplatin Compared With Bevacizumab/Gemcitabine/Cisplatin as First-Line Treatment for Advanced, Non-Squamous Non-Small Cell Lung Cancer and Associated Treatment Costs in the Private Mexican Health Care System

PCN33 Indirect Analysis of the Efficacy and Safety of Pemetrexed/Cisplatin Compared With Bevacizumab/Gemcitabine/Cisplatin as First-Line Treatment for Advanced, Non-Squamous Non-Small Cell Lung Cancer and Associated Treatment Costs in the Private Mexican Health Care System

PND18 Cost- Effectiveness of Fingolimod on Patients With Multiple Sclerosis at the Public Mexican Health Care System

PND18 Cost- Effectiveness of Fingolimod on Patients With Multiple Sclerosis at the Public Mexican Health Care System

PRS22 Cost-Effectiveness of Indacaterol on Patients with Chronic Obstructive Pulmonary Disease (Copd) at the Public Mexican Health Care System

PRS22 Cost-Effectiveness of Indacaterol on Patients with Chronic Obstructive Pulmonary Disease (Copd) at the Public Mexican Health Care System

Costo Efectividad de Posaconazol versus Fluconazol/Itraconazol en el Tratamiento Profiláctico de las Infecciones Fúngicas Invasivas en México

Cost effectiveness of posaconazole versus fluconazole/itraconazole therapy in the prophylaxis against invasive fungal Infections among high-risk neutropenic patients in Mexico. ObjectiveTo estimate the cost effectiveness and long-term combined effects of Posaconazole versus fluconazole/itraconazole (standard azole) therapy in the prophylaxis against invasive fungal Infections among high-risk neutropenic patients in Mexico. MethodsA previously validated Markov model was used to compare the projected lifetime costs and effects of two theoretical groups of patients, one receiving Posaconazole and the other receiving standard azole. The model estimates total costs, numbers of IFIs, and QALY per patient in each prophylaxis group. To extrapolate trial results to a lifetime horizon, the model was extended with one-month Markov cycles in which mortality risk is specific to the underlying disease. Data on the probabilities of IFI were obtained from Study Protocol PO1899. Drug costs were taken from average wholesale drug reports for 2009. Cost and health effects were discounted at 5% according to the Mexican guideline. The analysis was conducted from the Mexican healthcare perspective using 2008 unit cost prices. ResultsOur model projects an accumulated cost to the Mexican healthcare system per patient receiving the Posaconazol regimen of $US 5,634 compared to $US 7,463 for the standard azole regimen. The accumulated discounted effect is 3.13 LY or 2.25 QALYs per patient receiving Posaconazol, compared to 2.96 LY or 2.13 QALYs per patient receiving standard azole. Posaconazol remained the dominant strategy across each scenario. Probabilistic sensitivity analysis tested numerous assumptions about the model cost and efficacy parameters and found that the results were robust to most changes. ConclusionPosaconazole provides modest incremental benefits compared with standard azole therapy in the prophylaxis against IFIs among high-risk neutropenic patients. Routine Posaconazole use appears a cost saving when the likelihood of IFIs or the cost of treatment medications is high.

Diagnóstico de la enfermedad renal crónica como trazador de la capacidad técnica en la atención médica en 20 estados de México

To assess knowledge and technical capacity of primary care physicians in the management of patients with diabetes mellitus and high blood pressure as well as patients at risk of developing chronic kidney disease, and to use the latter condition as a tracer of the quality of primary care of the Mexican health system. A cross-sectional study included 149 primary health physicians in primary care units from state health care services in 20 states. An instrument with two clinical cases was applied. The average score of the physicians evaluated was 53.7 out of 100. Those physicians working in larger size units and graduated before the year 2000 tend to receive lower scores. The use of chronic kidney disease as a tracer of the technical capacity of the Mexican health care system is useful to understand the problems of primary care in the country's public settings.

Twenty-Five Years of Convoluted Health Reforms in Mexico

Nuria Homedes and Antonio Ugalde discuss 25 years of reform to the Mexican health care system and argue that although costs and accessibility have increased, health inequities, efficiency, productivity, and quality of care have not improved.

Economic impact of a rotavirus vaccination program in Mexico

To evaluate the cost and benefits of a national rotavirus childhood vaccination program in Mexico. A decision-analysis model was designed to take the Mexican health care system's perspective on a comparison of two alternatives: to vaccinate against rotavirus or not. Using published, national data, estimations were calculated for the rotavirus illnesses, deaths, and disability-adjusted life years (DALYs) that would be averted and the incremental cost-effectiveness ratios (US$/DALY) of a hypothetical annual birth cohort of 2 285 000 children, with certain assumptions made for cost, coverage, and efficacy rates. With 93% coverage and a vaccine price of US$ 16 per course (2 doses), a rotavirus vaccination program in Mexico would prevent an estimated 651 deaths (or 0.28 deaths per 1 000 children); 13 833 hospitalizations (6.05 hospitalizations per 1 000 children); and 414 927 outpatient visits (182 outpatient visits per 1 000 children) for rotavirus-related acute gastroenteritis (AGE). Vaccination is likely to reduce the economic burden of rotavirus AGE in Mexico by averting US$ 14 million (71% of the overall health care burden). At a vaccine price of US$ 16 per course, the cost-effectiveness ratio would be US$ 1 139 per DALY averted. A reduction in the price of the rotavirus vaccination program (US$ 8 per course) would yield a lower incremental cost-effectiveness ratio of US$ 303 per DALY averted. A national rotavirus vaccination program in Mexico is projected to reduce childhood incidence and mortality and to be highly cost-effective based on the World Health Organization's thresholds for cost-effective interventions.

Direct costs of osteoporosis and hip fracture: an analysis for the Mexican healthcare system

This study reports the direct costs related to osteoporosis and hip fractures paid for governmental and private institutions in the Mexican health system and estimates the impact of these entities on Mexico. We conclude that the economic burden due to the direct costs of hip fracture justifies wide-scale prevention programs for osteoporosis (OP). To estimate the total direct costs of OP and hip fractures in the Mexican Health care system, a sample of governmental and private institutions were studied. Information was gathered through direct questionnaires in 275 OP patients and 218 hip fracture cases. Additionally, a chart review was conducted and experts' opinions obtained to get accurate protocol scenarios for diagnoses and treatment of OP with no fracture. Microcosting and activity-based costing techniques were used to yield unit costs. The total direct costs for OP and hip fracture were estimated for 2006 based on the projected annual incidence of hip fractures in Mexico. A total of 22,233 hip fracture cases were estimated for 2006 with a total cost to the healthcare system of US$ 97,058,159 for the acute treatment alone ($4,365.50 per case). We found considerable differences in costs and the way the patients were treated across the different health sectors within the country. Costs of the acute treatment of hip fractures in Mexico are high and are expected to increase with the predicted increment of life expectancy and the number of elderly in our population.