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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. · 0.83 Impact Factor
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Environmental Health Perspectives 03/2012; 120(3):A104-5. · 7.04 Impact Factor
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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 08/2011; 27(1):50-62. · 0.64 Impact Factor
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Armando Arredondo
American Journal of Hypertension 03/2010; 23(3):224. · 3.18 Impact Factor
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ABSTRACT: The diagnosis of pancreatic cancer (PC) is most frequently established in advanced stages. The aim of this study is to estimate the likelihood ratios (LRs) of diagnostic data with regards to PC that could be used to approach an earlier diagnosis.
A case-control study of 300 patients - 150 histological diagnosed cases of PC and 150 age-matched controls hospitalized for study of jaundice, abdominal pain, weight loss and/or chronic pancreatitis - was conducted. Bayesian probabilities in the form of LRs were estimated for PC predictions.
Probability of PC was associated with jaundice [odds ratio (OR) 2.89; confidence interval (CI) 1.71-4.85], glycemic disturbance (OR 5.64; CI 2.36-13.46), tobacco index >20 (OR 2.11; CI 1.08-4.09) and tumour marker CA 19-9 (OR 9.33; CI 1.36-63.95). Computed tomography showed the highest test performance with regards to PC when comparing with other diagnostic tests. LRs for variables relevant to PC were estimated, among the most relevant: jaundice LR + 1.92, CA 19-9 LR + 5.36 and computed tomography LR + 4.15. The prediction model with an endoscopic retrograde cholangiopancreatography at a tertiary referral hospital determined a 67% probability of detecting PC.
Through a Bayesian approach we can combine clinical, laboratory and imaging data to approximate to an earlier diagnosis of PC.
Journal of Evaluation in Clinical Practice 03/2009; 15(1):62-8. · 1.23 Impact Factor
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ABSTRACT: This study analyzes the results of a cross-sectional survey which set out to determine the costs to patients of searching for and receiving health care in public and private institutions. The information analyzed was obtained from the study population of the Mexican National Health Survey. The dependent variable was the out-of-pocket users' costs and the independent variables were the insurance conditions, type of institution and income. The empirical findings suggest that there is a need for a more detailed analysis of user costs in middle income countries in general, where the health system is based on social security, public assistance and private institutions. This study shows that the out of pocket costs faced by users are inequitable and fall disproportionately upon socially and economically marginalized populations.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 01/2009; 24(12):2819-26. · 0.83 Impact Factor
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Armando Arredondo
American Journal of Hypertension 06/2008; 21(5):492. · 3.18 Impact Factor
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ABSTRACT: To determine health care costs and economic burden of epidemiological changes in diseases related to tobacco consumption.
A time-series analysis in Mexico (1994-2005) was carried out on seven health interventions: chronic obstructive pulmonary diseases, lung cancer with and without surgical intervention, asthma in smokers and non-smokers, full treatment course with nicotine gum, and full treatment course with nicotine patch. According with Box-Jenkins methodology, probabilistic models were developed to forecast the expected changes in the epidemiologic profile and the expected changes in health care services required for selected interventions. Health care costs were estimated following the instrumentation methods and validated with consensus technique.
A comparison of the economic impact in 2006 vs. 2008 showed 20-90% increase in expected cases depending on the disease (p<0.05), and 25-93% increase in financial requirements (p<0.01). The study data suggest that changes in the demand for health services for patients with respiratory diseases related to tobacco consumption will continue showing an increasing trend.
In economic terms, the growing number of cases expected during the study period indicates a process of internal competition and adds an element of intrinsic competition in the management of preventive and curative interventions. The study results support the assumption that if preventive programs remain unchanged, the increasing demands for curative health care may cause great financial and management challenges to the health care system of middle-income countries like Mexico.
Revista de Saúde Pública 08/2007; 41(4):523-9. · 1.33 Impact Factor
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ABSTRACT: Costs of health services for hypertension and the financial consequences of epidemiologic changes in this disease are important concerns for health systems in Latin America.
We conducted longitudinal analyses of the economic impact of the epidemiologic changes on health care services for hypertension in the Mexican health care system. The cost evaluation method used was based on costing technique by production function and consensus techniques. To estimate the epidemiologic changes and financial consequences for the period 2005 to 2007, three probabilistic models were constructed according to the Box-Jenkins technique.
If changes are not implemented in prevention programs to reduce the effects of current risk factors, there will be increases in the number of patients with hypertension as well as in the financial burden to treat the disease. The amount allocated for hypertension in 2007, which will be 6% to 8% of the total health budget, is US$ 2,486,145,132. Of these, US$ 1,178,725,132 will be direct costs and US$ 1,307,420,000 will be indirect costs. Regarding epidemiologic changes for 2005 v 2007 (P < .05), an increase is expected, although results show a greater increase in insured populations.
If the risk factors and different health programs remain as they currently are, the economic impact of expected epidemiologic changes on the social security system will be particularly strong. Another relevant financial factor is the appearance of internal competition in the allocation of financial resources among the main providers of health services for hypertension; this factor becomes even more complicated within each provider.
American Journal of Hypertension 06/2006; 19(6):553-9. · 3.18 Impact Factor
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ABSTRACT: To identify the effects of decentralization on health financing and governance policies in Mexico from the perspective of users and providers.
A cross-sectional study was carried out in four states that were selected according to geopolitical and administrative criteria. Four indicators were assessed: changes and effects on governance, financing sources and funds, the final destination of resources, and fund allocation mechanisms. Data collection was performed using in-depth interviews with health system key personnel and community leaders, consensus techniques and document analyses. The interviews were transcribed and analyzed by thematic segmentation.
The results show different effectiveness levels for the four states regarding changes in financing policies and community participation. Effects on health financing after decentralization were identified in each state, including: greater participation of municipal and state governments in health expenditure, increased financial participation of households, greater community participation in low-income states, duality and confusion in the new mechanisms for coordination among the three government levels, absence of an accountability system, lack of human resources and technical skills to implement, monitor and evaluate changes in financing.
In general, positive and negative effects of decentralization on health financing and governance were identified. The effects mentioned by health service providers and users were related to a diversification of financing sources, a greater margin for decisions around the use and final destination of financial resources and normative development for the use of resources. At the community level, direct financial contributions were mentioned, as well as in-kind contributions, particularly in the form of community work.
Revista de Saúde Pública 03/2006; 40(1):152-60. · 1.33 Impact Factor
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ABSTRACT: Objetivo: Identificar indicadores, tendencias y evidencias en materia de equidad en salud, desde la perspectiva de proveedores, usuarios de servicios y líderes de ONGs. Metodología: Se realizó una investigación cualitativa y cuantitativa en 7 Estados del país durante 2002-2005: Hidalgo, Oaxaca, Yucatán, Tabasco, Colima, Jalisco y Baja California Sur. Para el componente cualitativo, se aplicaron 210 entrevistas a profundidad a usuarios, proveedores de servicios, líderes de ONGs y tomadores de decisiones, las cuales se analizaron con apoyo del programa ATLAS-Ti; Para el componente cuantitativo, a partir de fuentes de datos secundarios de 85 fuentes de datos seleccionadas, se construyeron matrices de análisis sobre las tendencias en diferentes indicadores de equidad: asignación de recursos financieros y gasto en salud. Posteriormente se construyó un índice de inequidad en la asignación de recursos para el análisis de la equidad. Resultados: Desde una perspectiva cualitativa, los resultados muestran evidencias de fortalezas y debilidades en materia de equidad; particularmente se resalta que las formulas actuales de asignación de recursos para la salud no son las adecuadas para satisfacer las demandas locales de servicios de salud. Desde una perspectiva cuantitativa, los diferentes indicadores desarrollados permiten identificar patrones de desigualdad que no han cambiado en los últimos 15 años, muy a pesar de las estrategias de mejora en la equidad que plantea el actual Programa Nacional de Salud. Conclusión: La equidad en salud no cuenta con mecanismos suficientes de participación, monitoreo y de rendición de cuentas que permitan avanzar en el equilibrio entre las necesidades de salud y los recursos que se asignan por área geográfica o nivel estatal.
Salud en Tabasco. 01/2006;
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ABSTRACT: To identify trends and to describe the impact of health care decentralization on health financing policies in Mexico.
The study population comprised four states selected according with six technical criteria: socioeconomic development, implementation of decentralization process, database on economical features, data consistency and reliability, and technical support from a multidisciplinary team. In-depth interviews with key personnel as well as analysis of technical reports of state budgets for health in the period 1990-2000 were conducted.
The analysis model applied allowed to determine the trends and the impact of health care decentralization on main financing sources: householders, and federal, state and municipal governments. There was evidence of different change effectiveness, especially regarding trends of financing per source.
There are states where householders and state and municipal governments effectively increased financing support for health care system. But there are also states where householders and state and municipal governments do not agree on the increase of financing support for health care system.
Revista de Saúde Pública 03/2004; 38(1):121-9. · 1.33 Impact Factor
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ABSTRACT: To identify the costs and economic consequences of expected changes in the demand for health care services for type 2 diabetes in the three main public institutions of the Mexican health care system.
The cost evaluation method to estimate direct and indirect costs was based on instrumentation and consensus techniques. To estimate the costs and epidemiological changes for 2003-2005, three probabilistic models were constructed according to the Box-Jenkins technique.
Comparing the economic impact in 2003 versus 2005 (P < 0.05), there is a 26% increase in financial requirements. The total amount for diabetes in 2005 (in U.S. dollars) will be 317,631,206, dollars including 140,410,816 dollars in direct costs and 177,220,390 dollars in indirect costs. The total direct costs, representing financial requirements to provide health care for expected cases of type 2 diabetes and its main complications in the three main public institutions in Mexico, up to 2005, will be 37,079,587 dollars for the Ministry of Health (or Secretaría de Salud [SSA], serving the uninsured population) and 103,331,235 dollars for the Mexican Social Security Institute, or Instituto Mexicano del Seguro Social (IMSS), and the Institute for Social Security and Services for State Workers, or Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), both of which serve the insured population.
Our data suggest that changes in the demand for health care services for patients with diabetes will continue with an increasing trend, mainly in the insured population. In economic terms, the results of direct and indirect costs are one of the main challenges to be solved to decrease the economic burden that diabetes represents for the population, the health care institutions, and for society as a whole.
Diabetes Care 02/2004; 27(1):104-9. · 8.09 Impact Factor
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ABSTRACT: The objective of this study was to do an epidemiological and costs analysis of the impact of road traffic injuries on the demand for emergency room services at hospitals located in the city of Cuernavaca, Mexico. The studied population included injured people who demanded medical attention at the emergency room for injuries due to events in public places, occurring between February and April 2001. Trained interviewers collected the data at the emergency room, 24h a day. The statistical analysis included simple and bivariate analysis using chi(2) odds ratio (OR), and a confidence interval of 95%. The costs analysis included the expenses during the process of searching for and finding care for injuries. There were 433 injured people, 233 (54%) were victims of road traffic accidents, 72% of crashes, and 28% were injured pedestrian and cyclists. Variables associated with the demand of emergency care due to road traffic injuries in comparison with other accidents, were: severity of injuries (OR 2.60, CI 1.44-4.71), and thorax injury (OR 4.64, CI 1.03-20.89). Pedestrians had higher costs for health care and 80% of them had to pay out-of-pocket (P<0.05). Differences between patients injured by crashes or as a pedestrian, were: age under 14 years (OR 5.9, CI 2.5-13.9), being unemployed (OR 2.1, CI 1.20-3.96), and being an elementary school student (OR 13.9, CI 3.08-63.13). The present study is, so far, the only one in Mexico to include an epidemiological and costs analysis in approaching the problem of road traffic injuries. Similar methods must be used, especially in developing countries, to reduce this important public health problem.
Accident Analysis & Prevention 01/2004; 36(1):37-42. · 1.87 Impact Factor
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ABSTRACT: The main objective of this study was to identify trends and results associated with health financing and governance indicators in the context of health systems reform. Evaluative research integrating qualitative and quantitative analysis was performed. The three Latin American countries of Mexico, Nicaragua, and Peru were selected as the universe of study. The research methodology had two main phases. In the first phase, the study referred to secondary sources of data and documents to obtain information about the following variables: type of decentralization implemented, source of finance, funds of financing, providers, final use of resources and mechanisms for resource allocation. In the second phase, the study referred to primary data collected in a survey of key personnel from the health sectors of each country. Results showed that evidence reported in all five financing and governance indicators may identify the major weaknesses and strengths in health financing. In addition, there was a lack of human resources trained in health economics who can implement changes, a lack of financial resources independence between the local and central levels, negative behavior of the main macro-economic variables, and difficulty in developing new financing alternatives. However, other results showed that there was a sharing between the central and local government levels in the financing health services, the implementation of new organizational structures for the follow-up of financial changes at the local level, the development and implementation of new financial allocation mechanisms taking into account efficiency and equity principles, new technique of a per-capita adjustment factor corrected at the local health needs, and the increase of financing contributions from households and local levels of government.
International Journal of Economic Development Volume Six. 01/2004; 3:112-138.
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ABSTRACT: OBJETIVO: Identificar las tendencias y los efectos de la descentralización en las políticas de financiamiento de la salud en México. MÉTODOS: La población de estudio incluyó cuatro estados seleccionados bajo criterios técnicos: diferente desarrollo socio-económico; implementación de la descentralización; base de datos sobre información económica; confiabilidad y validéz de las bases de datos; y apoyo de un equipo interdisciplinario de investigación. Las técnicas de recopilación de información se basaron en entrevistas a profundidad con personal clave y análisis de documentos y bases de datos sobre los presupuestos estatales en salud para el período 1990-2000. RESULTADOS: El modelo de análisis propuesto permitió identificar las tendencias y efectos de la descentralización sobre las principales fuentes de financiamiento en salud: Hogares, Gobiernos Federal, Estatal y Municipal. Hay evidencias de niveles de efectividad muy variada en cuanto a los cambios en las políticas de financiamiento, particularmente en lo que se refiere a las tendencias en los montos económicos por tipo de fuente de financiamiento. CONCLUSIONES: Hay estados donde los hogares, los municipios y el mismo gobierno estatal han hecho efectivo un incremento importante en el financiamiento de la salud, pero también hay Estados donde continúa la dependencia económica del nivel federal y donde Hogares, Municipios y Estados no están dispuestos ni capacitados para asumir responsabilidad económica en materia de salud.
Revista de Saúde Pública. 01/2004;
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ABSTRACT: There are four different conceptual approaches to assess the factors that explain, condition and determine the use of health services. This article discusses the epidemiological, psychosocial, sociological and economical models. The stages and determinants of the health service use process are described and a cross study is made with each of the four models, using a contingency matrix. A holistic analysis is proposed, as a starting point, for the search of a model that will allow the identification of factors that determine the use of health services. This analysis should be used as a conceptual framework for future work on health services utilization.
Revista medica de Chile 05/2003; 131(4):445-53. · 0.33 Impact Factor
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ABSTRACT: El objetivo de este análisis fue determinar efectos de ladescentralización en el financiamiento de la salud en México.Se trató de una investigación evaluativa que incluyó comopoblación de estudio a cuatro estados mexicanos. El modelode análisis propuesto permitió identificar el destino final ymecanismos de asignación de los recursos financieros parael sector salud. Las técnicas de recopilación de informaciónse basaron en entrevistas a profundidad con personal clavey análisis de documentos y bases de datos sobre lospresupuestos estatales en salud para el período 1990-2000.Los resultados plantean niveles de efectividad muy variadaen cuanto al destino final de los recursos y los nuevosmecanismos de asignación . En efecto, hay estados donde sise están aplicando mecanismos de asignación financiera quese basa en nuevos criterios técnicos (epidemiológicos,clínicos o económicos). Existen estados donde los mismoscambios en los mecanismos de asignación han permitidomayor flexibilidad en el manejo financiero y los recursos sereasignan en función de las prioridades locales de salud. Enlo referente al destino final de los recursos por tipo deservicio, se determinó una tendencia de mayor equilibrioentre programas preventivos y programas curativos.
Salud en Tabasco. 01/2003;
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ABSTRACT: This paper presents the results from a longitudinal study in which the main purpose was to determine the health-care costs and financial consequences of changes in the health care demands related to tobacco consumption in Mexico. Eleven health interventions were selected to conduct this study and four probabilistic models were developed to forecast the expected changes in the epidemiologic profile of selected diseases. The costing method was based on the identification of case management costs using the instrumentation and consensus techniques, probabilistic models were designed using the Box-Jenkins technique and allowed us to identify the expected case trends for the 2001-2003 period. The generation of information on case management costs for the selected interventions is a central instrument in the planning of health programs, above all in that which refers to resource allocation by type of demand. On the other hand, the identification of expected cases and the financial consequences allowed us to know the growing trends of the sums required to satisfy health care demands for the period under study. The three types of information are a relevant resource for decision-makers in the production and financing of health services.
Health Policy 08/2002; 61(1):43-55. · 1.51 Impact Factor
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ABSTRACT: This article presents the results from an evaluative longitudinal study with before–after design. The main objective was to determine the effects of health care decentralization on changes in health financing. Taking into account feasibility, political and technical criteria, three Latin American countries were selected as study populations: Mexico, Nicaragua and Peru. The methodology had two main phases. In the first phase, the study referred to secondary sources of data and documents to obtain information about the following variables: type of decentralization implemented, source of finance, funds of financing, providers, final use of resources and mechanisms for resource allocation. In the second phase, the study referred to primary data collected in a survey of key personnel from the health sectors of each country. Taking into account the changes implemented in the three countries, as well as the strengths and weaknesses of each country in financing and decentralization, a rule for decision-making is proposed that attempts to identify the main financial changes implemented in each country and the basic indicators that can be used in future years to direct the planning, assessment, adjustment and correction of health financing and decentralization. Copyright © 2001 John Wiley & Sons, Ltd.
International Journal of Health Planning and Management 06/2001; 16(3):259 - 276. · 0.64 Impact Factor
