[Show abstract][Hide abstract] ABSTRACT: Background:
In order to identify the challenges resulting from hypertension in a middle income country, this study has developed probabilistic models to determine the epidemiological and economic burden of hypertension in Mexico.
Considering a population base of 654,701 reported cases of adults with hypertension, we conducted a longitudinal analyses in order to identify the challenges of epidemiological changes and health care costs for hypertension in the Mexican health system. The cost-evaluation method used was based on the instrumentation technique. To estimate the epidemiological changes for 2015-2017, probabilistic models were constructed according to the Box-Jenkins technique.
Regarding changes in expected cases for 2015 vs. 2017, an increase of 12 % is expected (p < 0.001). Comparing the economic impact in 2015 versus 2017 (p < 0.001), there is a 23 % increase in financial requirements. The total amount for hypertension in 2016 (US dollars) will be $6306,685,320 Of these, $ 2990,109,035 will be as direct costs and $ 3316,576,285 as indirect costs.
If the risk factors and care models remain as they are currently in the health system, the financial consequences will have a major impact on the out-of-pocket users, following in order of importance, on social security providers and on public assistance providers.
BMC Public Health 11/2015; 15(1):1106. DOI:10.1186/s12889-015-2430-x · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The study of health disparities and the five areas of scientific training, seen from a transdisciplinary approach set forth in the article by Golden et al.,(1) is one of the recent excellent contributions to addressing comprehensively the effects of health hazards in cardiovascular diseases (CVDs), which the biomedical focus has not been able to solve. Certainly, the creation of a research center with a transdisciplinary approach, which will contribute to reducing health disparities that generate CVDs in any population group, is a strategy that we must promote and enrich with lessons learned in other countries. In the case of scientific training in México, we are also incorporating into this transdisciplinary perspective an ecosystemic approach developed in Canada.(2) (Am J Public Health. Published online ahead of print August 13, 2015: e1-e2. doi:10.2105/AJPH.2015.302824).
American Journal of Public Health 08/2015; 105(10):e1-e2. DOI:10.2105/AJPH.2015.302824 · 4.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This article includes evidence on equity, governance and health financing outcomes of the Mexican health system. An evaluative research with a cross-sectional design was oriented towards the qualitative and quantitative analysis of financing, governance and equity indicators. Taking into account feasibility, as well as political and technical criteria, seven Mexican states were selected as study populations and an evaluative research was conducted during 2002–2010. The data collection techniques were based on in-depth interviews with key personnel (providers, users and community leaders), consensus technique and document analysis. The qualitative analysis was done with ATLAS TI and POLICY MAKER soft wares. The Mexican health system reform has modified dependence at the central level; there is a new equity equation for resources allocation, community leaders and users of services reported the need to improve an effective accountability system at both municipal and state levels. Strategies for equity, governance and financing do not have adequate mechanisms to promote participation from all social actors. Improving this situation is a very important goal in the Mexican health democratization process, in the context of health care reform. Inequality on resources allocation in some regions and catastrophic expenditure for users is unequal in all states, producing more negative effects on states with high social margin-alization. Special emphasis is placed on the analysis of the main strengths and weaknesses, as relevant evidences for other Latin American countries which are designing, implementing and evaluating reform strategies in order to achieve equity, good governance and a greater financial protection in health.
Saude e Sociedade 07/2015; 24:162-175. DOI:10.1590/S0104-12902015S01014 · 0.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The need to integrate economic and epidemiological aspects in the clinical perspective leads to a proposal for the analysis of health disparities and to an evaluation of the health services and of the new challenges which are now being faced by health system reforms in middle income countries.
To identify the epidemiological changes, the demand for health services and economic burden from chronic diseases (diabetes and hypertension) in a middle income county.
We conducted longitudinal analyses of costs and epidemiological changes for diabetes and hypertension in the Mexican health system. The study population included both the insured and uninsured populations. The cost-evaluation method was used, based on the instrumentation and consensus techniques. To estimate the epidemiological changes and financial consequences for 2014-2016, six models were constructed according to the Box-Jenkins technique, using confidence intervals of 95%, and the Box-Pierce test.
Regarding epidemiological changes expected in both diseases for 2014 vs. 2016, an increase is expected, although results predict a greater increase for diabetes, 8-12% in all three studied institutions, (p < .05). Indeed, in the case of diabetes, the increase was 41469 cases for uninsured population (SSA) and 65737 for the insured population (IMSS and ISSSTE). On hypertension cases the increase was 38109 for uninsured vs 62895 for insured. Costs in US$ ranged from $699 to $748 for annual case management per patient in the case of diabetes, and from $485 to $622 in patients with hypertension. Comparing financial consequences of health services required by insured and uninsured populations, the greater increase (23%) will be for the insured population (p < .05). The financial requirements of both diseases will amount to 19.5% of the total budget for the uninsured and 12.5% for the insured population.
If the risk factors and the different health care models remain as they currently are, the economic impact of expected epidemiological changes on the social security system will be particularly strong. Another relevant challenge is the appearance of internal competition in the use and allocation of financial resources with programs for other chronic and infectious diseases.
PLoS ONE 03/2015; 10(3):e0118611. DOI:10.1371/journal.pone.0118611 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Despite advances in medicine, health systems in Latin America are not coping with the challenges of chronic diseases. Incidence of disease and the economic burdens as a consequence have both increased in recent years. We have chosen Type 2 diabetes as an example to highlight the challenges posed by chronic diseases, in terms of the epidemiological transition and the economic burden of the demand for services to treat such problems.
Current health systems are not prepared to respond in a comprehensive manner to all phases of the natural history of the disease. There are new models of universal coverage, but resources and models of care are focused on programs aimed at healing/rehabilitation, and very sparsely at detection/prevention.
In this scenario, chronic problems have alarmingly increased direct costs (medical care) and indirect costs (temporary disability, permanent disability and premature mortality). If more resources are not assigned to preventive medicine, these trends, in addition to not meeting the needs of the population, will financially collapse health systems and the patients’ pockets. This Opinion piece outlines some possible changes that can be implemented to better prepare the health services in Latin American countries.
BMC Medicine 08/2014; 12(1):136. DOI:10.1186/s12916-014-0136-z · 7.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The rapid growth of diabetes in middle-income countries is generating disparities in global health. In this context we conducted a study to quantify the health disparities from the economic burden of diabetes in México. Evaluative research based on a longitudinal design, using cost methodology by instrumentation. For the estimation of epidemiological changes during the 2010-2012 period, several probabilistic models were developed using the Box-Jenkins technique. The financial requirements were obtained from expected case management costs by disease and the application of an econometric adjustment factor to control the effects of inflation. Comparing the economic impact in 2010 versus 2012 (p<0.05), there was a 33% increase in financial requirements. The total amount for diabetes in 2011 (US dollars) was $7.7 billion. It includes $3.4 billion in direct costs and $4.3 in indirect costs. The total direct costs were $.4 billion to the Ministry of Health (SSA), serving the uninsured population; $1.2 to the institutions serving the insured population (Mexican Institute for Social Security-IMSS-, and Institute for Social Security and Services for State Workers-ISSSTE-); $1.8 to users; and $.1 to Private Health Insurance (PHI). If the risk factors and the different health care models remain as they currently are in the analyzed institutions, health disparities in terms of financial implications will have the greatest impact on users' pockets. In middle-income countries, health disparities generated by the economic burden of diabetes is one of the main reasons for catastrophic health expenditure. Health disparities generated by the economic burden of diabetes suggests the need to design and review the current organization of health systems and the relevance of moving from biomedical models and curative health care to preventive and socio-medical models to meet expected challenges from diseases like diabetes in middle-income countries.
PLoS ONE 07/2013; 8(7):e68443. DOI:10.1371/journal.pone.0068443 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
In many low-income to middle-income countries where there are limited economic resources, willingness to spend money is low. There is a need for analysis of the effects of small changes in willingness to pay (WTP) for health care to inform decision making in drug selection. Our goal in this study was to analyse the cost-effectiveness of oral hypoglycaemic agents (OHAs) for the initial treatment of non-obese outpatients diagnosed with type 2 diabetes in a resource-poor setting.Methods
We performed a probabilistic sensitivity analysis to analyse the cost-effectiveness of three OHAs: metformin, glibenclamide, and acarbose. We used specialised software for programming a Markov model designed for a horizon time of 1 year considering 6 months for monotherapy and 6 months for combined oral dual therapy. Meta-analysis techniques were performed for the study of effectiveness and surveys for costs estimations. For the probabilistic sensitivity analysis we used distributions of probabilities as beta distributions and monthly costs as lognormal distributions of therapeutic alternatives. We performed a Monte Carlo simulation for a cohort of 10 000 patients for each treatment option.FindingsThe results of the Monte Carlo simulations were very close for metformin and glibenclamide, showing their strong dominance over acarbose. In the acceptability curve generated, for a WTP equal to 0 the probabilities of the therapies to be cost effective were 49·5%, 43·0%, and 7·5% for glibenclamide, metformin, and acarbose, respectively. In the glibenclamide versus metformin incremental cost-effectiveness analysis, the change of the WTP from 0 to 1 gross domestic product per capita by quality-adjusted life-year, the proportion of cost-effective iterations favouring glibenclamide increased from 53·4% to 59·7%.InterpretationThe initial drug therapies with glibenclamide or metformin are dominant over therapy with acarbose. Glibenclamide is slightly more cost effective than metformin in the treatment of non-obese outpatients diagnosed with type 2 diabetes. This kind of analysis is important for drug selection in low-income to middle-income countries.FundingNational Commission for Science and Technology supported a grant for the first author.
The Lancet 06/2013; 381:S38. DOI:10.1016/S0140-6736(13)61292-1 · 45.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Mexico has been experiencing some of the most rapid shifts ever recorded in dietary and physical activity patterns leading to obesity. Diabetes mellitus has played a crucial role causing nearly 14% of all deaths. We wanted to make a comprehensive study of the role of diabetes in terms of burden of disease, prevalence, cost of diabetes, cost of complications and health policy.
We review the quantitative data that provides evidence of the extent to which the Mexican health economy is affected by the disease and its complications. We then discuss the current situation of diabetes in Mexico with experts in the field.
There was a significant increase in the prevalence of diabetes from 1994 to 2006 with rising direct costs (2006: outpatient USD$ 717,764,787, inpatient USD$ 223,581,099) and indirect costs (2005: USD$ 177,220,390), and rising costs of complications (2010: Retinopathy USD$ 10,323,421; Cardiovascular disease USD$ 12,843,134; Nephropathy USD$ 81,814,501; Neuropathy USD$ 2,760,271; Peripheral vascular disease USD$ 2,042,601). The health policy focused on screening and the creation of self-support groups across the country.
The increasing diabetes mortality and lack of control among diagnosed patients make quality of treatment a major concern in Mexico. The growing prevalence of childhood and adult obesity and the metabolic syndrome suggest that the situation could be even worse in the coming years. The government has reacted strongly with national actions to address the growing burden posed by diabetes. However our research suggests that the prevalence and mortality of diabetes will continue to rise in the future.
Globalization and Health 02/2013; 9(1):3. DOI:10.1186/1744-8603-9-3 · 2.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The rapid growth of diabetes in older adults represents a global event with broad challenges for public health systems at a world level. As explained in Caspersen et al.,(1) diabetes and its complications are a great economic challenge for any health system, particularly when the disease is present in older adults. This is because of the high prevalence of complications in older adults in any society. Because diabetes represents an economic burden, the financial pressure that it places on public health systems might cause these systems to collapse. In this sense, the policy proposal to broaden public health systems and make them more effective is an urgent one for the globe and cannot be deferred. (Am J Public Health. Published online ahead of print December 13, 2012: e1-e2. doi:10.2105/AJPH.2012.301106).
American Journal of Public Health 12/2012; 103(2). DOI:10.2105/AJPH.2012.301106 · 4.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective:
To identify policies that increase access to health care for undocumented Mexican immigrants.
Materials and methods:
Four focus groups (n=34 participants) were conducted with uninsured Mexican immigrants in Los Angeles, California. The feasibility and desirability of different policy proposals for increasing access were discussed by each group.
Respondents raised significant problems with policies including binational health insurance, expanded employer-provided health insurance, and telemedicine. The only solution with a consensus that the change would be feasible, result in improved access, and they had confidence in was expanded access to community health centers (CHC's).
Given the limited access to most specialists at CHC's and the continued barriers to hospital care for those without health insurance, the most effective way of improving the complete range of health services to undocumented immigrants is through immigration reform that will bring these workers under the other health care reform provisions.
Salud publica de Mexico 12/2012; 55(Suppl 4):s508-s514. · 0.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to assess the costs and financial consequences of epidemiological changes in hypertension in Mexico. The cost evaluation method to estimate costs was based on instrumentation techniques. To estimate the epidemiological changes and expected cases of hypertension in 2010-2012, three probabilistic models were constructed according to the Box-Jenkins technique. Comparing the economic impact, from 2010 to 2012 there will be a 24% increase in financial requirements (p < 0.05). The total cost of hypertension in 2011 will be US$ 5,733,350,291, including US$ 2,718,280,941 in direct costs and US$ 3,015,069,350 in indirect costs. If the risk factors and various healthcare models remain unaltered in the institutions analyzed here, the financial consequences will have a major impact on users' pockets, followed by social security providers and public healthcare providers. The authors suggest a revision in the planning, organization, and allocation of resources, particularly programs for health promotion and prevention of hypertension.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 03/2012; 28(3):497-502. DOI:10.1590/S0102-311X2012000300010 · 0.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the impact of a workplace leisure physical activity program on healthcare expenditures for type 2 diabetes and hypertension treatment.
We assessed a workplace program's potential to reduce costs by multiplying the annual healthcare costs of patients with type 2 diabetes and hypertension by the population attributable risk fraction of non-recommended physical activity levels. Feasibility of a physical activity program was assessed among 425 employees of a public university in Mexico.
If 400 sedentary employees engaged in a physical activity program to decrease their risk of diabetes and hypertension, the potential annual healthcare cost reduction would be 138 880 US dollars. Each dollar invested in physical activity could reduce treatment costs of both diseases by 5.3 dollars.
This research meets the call to use health economics methods to re-appraise health priorities, and devise strategies for optimal allocation of financial resources in the health sector.
Salud publica de Mexico 02/2012; 54(1):20-7. DOI:10.1590/S0036-36342012000100004 · 0.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To assess the impact of a workplace leisure physical activity program on healthcare expenditures for type 2 diabetes and hypertension treatment. MATERIAL AND METHODS: We assessed a workplace program's potential to reduce costs by multiplying the annual healthcare costs of patients with type 2 diabetes and hypertension by the population attributable risk fraction of non-recommended physical activity levels. Feasibility of a physical activity program was assessed among 425 employees of a public university in Mexico. RESULTS: If 400 sedentary employees engaged in a physical activity program to decrease their risk of diabetes and hypertension, the potential annual healthcare cost reduction would be 138 880 US dollars. Each dollar invested in physical activity could reduce treatment costs of both diseases by 5.3 dollars. CONCLUSIONS: This research meets the call to use health economics methods to re-appraise health priorities, and devise strategies for optimal allocation of financial resources in the health sector.
Salud publica de Mexico 02/2012; 54(1):20-27. · 0.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This article aims to identify opportunities, barriers and challenges in Mexico's policy networks for the development of healthcare programs for undocumented migrants in the USA and their families.
We used policy analysis, in-depth interviews and a case study. Key stakeholders at the federal, state and municipal levels in one major migrant-sending state were interviewed. We also conducted an in-depth case study of one community to obtain the perceptions of local health workers, migrant families and local nongovernmental organizations.
Findings identified opportunities and barriers involving the stakeholders, institutions, social interactions and types of relationships necessary for further progress on binational policies. There was wide interest in creating binational health insurance with different degrees of potential involvement by political actors and variation in local actors' willingness to be covered by some type of health insurance scheme.
The use of the opportunities to overcome barriers depends on the identification of high, medium or low interaction among key stakeholders, integration of coalitions and negotiating skills of all stakeholders involved.
International Journal of Health Planning and Management 01/2012; 27(1):50-62. DOI:10.1002/hpm.1100 · 0.97 Impact Factor