Health care utilization among older Mexicans: Health and socioeconomic inequalities

Maryland Population Research Center, University of Maryland, College Park, MD 20742, USA.
Salud publica de Mexico (Impact Factor: 0.94). 02/2007; 49 Suppl 4(Suppl 4):S505-14. DOI: 10.1590/S0036-36342007001000010
Source: PubMed


To examine the determinants of the utilization of health care services among the population of older adults in Mexico. Three types of health care services are analyzed: preventive care, visits to the doctor, and hospitalizations.
Data was used from the 2001 Mexican Health and Aging Study (MHAS/ENASEM) and estimates were made using multivariate probit regression methods.
Socioeconomic factors, health conditions reported by the individuals, and the availability of health insurance are significant determinants of the differential use of services by older adults.
Specific health conditions are important determinants of use of the various types of health care services. For all three types, however, the availability of health insurance is an enabling factor of health care use. Older age is associated with greater propensity to use health care services but its effect is small when controlling for health conditions.

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Available from: Rebeca Wong, Aug 26, 2014
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    • "Urban areas have more extensive and developed formal labour markets with access to social security services and a greater variety of private health services. In contrast, the majority of the labour market in rural areas is informal, resulting in a less extensive presence of social insurance services and more participation of the MoH health services [40]. "
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    ABSTRACT: A common characteristic of health systems in most developing countries is unequal access to health services. As a result, members of the poorest population groups often do not receive formal attention for health services, because they cannot afford it. In 2001 in Mexico, to address income-related differences in the use of health services, the government launched a major healthcare reform, which includes a health insurance program called Seguro Popular, aimed at improving healthcare access among poor, uninsured residents. This paper analyzes the before and after changes in the demand for curative ambulatory health services focusing on the association of income-related characteristics and the utilization of formal healthcare providers vs. no healthcare service utilization. By using two nationally representative health surveys (ENSA-2000 and ENSANUT-2006), we modeled an individual's decision when experiencing an illness to use services provided by the (1) Ministry of Health (MoH), (2) social security, (3) private entities, or (4) to not use formal services (no healthcare service utilization). Poorer individuals were more likely in 2006 than in 2000 to respond to an illness by using formal healthcare providers. Trends in provider selection differed, however. The probability of using public services from the MoH increased among the poorest population, while the findings indicated an increase in utilization of private health services among members of low- and middle-income groups. No significant change was seen among formal workers -covered by social security services-, regardless of socioeconomic status. Overall, for 2006 the Mexican population appears less differentiated in using healthcare across economic groups than in 2000. This may be related, in part, to the implementation of Seguro Popular, which seems to be stimulating healthcare demand among the poorest and previously uninsured segment of the population. Still, public health authorities need to address the remaining income-related healthcare utilization differences, the differences in quality between public and private health services, and the general perception that MoH facilities offer inferior services.
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    • "In terms of geographical areas, 7 out of every 100 rural women, 17 out of every 100 peri-urban women and 19 out of every 100 urban women possessed health insurance coverage, which reinforced the aforementioned findings that income plays a critical role in health insurance coverage and health status. These results are not in agreement with findings from a study by Wong and Diaz[27], who found that almost three-quarters of the urban population (73%) have coverage compared to 38% of those in rural areas; women showed a slightly higher and similar coverage (56%) than men (52%). Bennett et al.[28] postulated that rural residents were more likely to be uninsured than urban residents (17.8% versus 15.3%), and that rural respondents were more likely than urban counterparts to report having deferred health care because of cost (15.1% versus 13.1%). "
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    • "Recent publications show that access to health insurance in Mexico increases the use of conventional health care services, more specifically of doctor visits, hospitalization, and preventive exams (Wong and Díaz, 2007; Pagán, Puig and Soldo, 2007) and reduces the use of alternative and traditional medicine (Van Gameren, 2010). Hence, for Mexicans living in Mexico, a substitution away from non-proven methods toward conventional medical services is found. "
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