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The Impact of Economic Crisis and Adjustment on Health Care in Mexico
... Cornia (1994:44) showed that combined spending on health and education in Latin America fell from 24.4% of the budget in 1980-1981 to 18.4% in 1985-1987. In Mexico, for example, health care expenditure fell by 53% between 1981 and 1987 (Rivero, Ascencio and Vinagre 1991). Though the country continued to expand the coverage of health services, the quality of health services declined. ...
... That effect was apparent in the dramatic slowdown in the rate of decline of child mortality to only 4% in the 1978-1982 period. Rivero et al. (1991) also noted that others had observed similar effects in Brazil. ...
... En relación con la ineficiencia en la asignación se observa que en México las actividades curativas son las que consumen un mayor presupuesto en relación con las actividades preventivas. 32 Asimismo, en el país el problema de la "presupuestación inercial", es decir la asignación de presupuesto con base en el presupuesto ejercido el año anterior, ha permitido que se perpetúen las asignaciones de presupuesto incorrectas y además que las unidades médicas no tengan un incentivo para ahorrar, pues si ahorran se les quita presupuesto futuro. 33 La ineficiencia en la asignación se debe, en mucho, a la falta de información sobre el costo y la efectividad de las intervenciones 34, 35 y el presupuesto responde en gran medida a situaciones inerciales y a presiones de grupos de interés que generan grandes ineficiencias. ...
... Desarrollar el marco normativo para la libre transportabilidad de la medicina de familia entre proveedores y aseguradoras. 32. Diseñar e instrumentar nuevas formas de remuneración al personal de medicina de familia que incluyan pagos por capitación, ajustados por edad y sexo que integren incentivos a la productividad y calidad de la atención. ...
Analizar al Sistema Nacional de Salud desde una perspectiva económica, identificando las sinergias positivas con otros sectores de la economía, su problemática financiera, la relevancia del “Complejo Médico Industrial” y sus potencialidades como actor económico; así como estudiar las fortalezas, amenazas, debilidades y oportunidades que enfrentará el Sistema de Salud en el periodo 2007 – 2012 y la generación de una serie de recomendaciones de política para la consolidación del aseguramiento universal en salud en México.
Objetivos específicos: Realizar un Diagnóstico del Financiamiento del Sistema Nacional de Salud.
Analizar las sinergias positivas, los costos y los beneficios entre la Política de Salud y las Políticas: Fiscal, Social y de Combate a la Pobreza, Laboral, Educativa, del Medio Ambiente, del Sector Externo y Comercial y del Sector Turismo.
Estudiar las: Fortalezas, Amenazas, Debilidades y Oportunidades que enfrenta el Sistema Nacional de Salud y el Complejo Médico Industrial para el periódo 2007 – 2012
Proponer una serie de recomendaciones de política para la consolidación del Sistema de Aseguramiento Universal en Salud, para el desarrollo del Complejo Médico Industrial Mexicano y para la Sinergia Positiva entre la Política de Salud y otras Políticas Sectoriales.
La estructura de gasto familiar en México está muy restringida, sus efectos sobre el gasto de bolsillo en salud son: porcentaje de gasto en salud bajo e insuficiente para resolver las necesidades de atención, primeros deciles de ingreso aplazarán gastar hasta que se presente una demanda ineludible; y aunados a la incipiente política social en salud que incrementan la probabilidad de incurrir en gastos catastróficos. Cuando se analiza por hogares la ENIGH 2006, 42% no reportó gasto en salud, 44% reportó gasto de bolsillo en salud sin que fuera catastrófico y 14% sufrió un gasto de bolsillo en salud catastrófico. Los dos rubros de gasto más importantes en materia de Cuidados Médicos y Conservación de la Salud son los Medicamentos, según la ENIGH 2006, el 1° decil de ingreso destinó 37.3% de su gasto de bolsillo en salud a medicamentos no recetados, 28.6% en medicamentos recetados, en total de 66%. Se estima la probabilidad de que un hogar que ha realizado gasto en medicamentos, sufra gasto catastrófico; se utiliza un modelo Probit cuya variable dependiente es gasto catastrófico / gasto no catastrófico y los regresores son condiciones de derechohabiencia, escolaridad, índice de dependencia económica y decil de ingreso. Resultados: los hogares con derechohabiencia tienen factor de protección 32% de tener gastos catastróficos; hogares con niños y ancianos incrementan un 27% su probabilidad y los primeros 4 deciles tienen el doble de probabilidad de gasto catastrófico sobre el resto de los deciles.
... Cornia (1994:44) showed that combined spending on health and education in Latin America fell from 24.4% of the budget in 1980-1981 to 18.4% in 1985-1987. In Mexico, for example, health care expenditure fell by 53% between 1981 and 1987 (Rivero, Ascencio and Vinagre 1991). Though the country continued to expand the coverage of health services, the quality of health services declined. ...
... That effect was apparent in the dramatic slowdown in the rate of decline of child mortality to only 4% in the 1978-1982 period. Rivero et al. (1991) also noted that others had observed similar effects in Brazil. ...
This paper argues that the twin attributes of public ownership of the heavily indebted poor country (HIPC) debt, and the relative systemic irrelevance of these countries' economic performance led to an almost decade-long delay in the provision of substantial debt relief for these countries. While private creditors were forced to come to terms with the middle-income country debt, public creditors could afford to sustain the fiction of a liquidity crisis much longer (implying little need for debt reduction). This delay was costly for these countries as they fell behind other countries of comparable income levels in both human and economic development terms. The paper also offers some estimates of the size of the debt overhang facing these countries, and hence potential bases for determining the adequacy of current debt-reduction efforts.
... Cornia (1994:44) showed that combined spending on health and education in Latin America fell from 24.4% of the budget in 1980-1981 to 18.4% in 1985-1987. In Mexico, for example, health care expenditure fell by 53% between 1981 and 1987 (Rivero, Ascencio and Vinagre 1991). Though the country continued to expand the coverage of health services, the quality of health services declined. ...
... That effect was apparent in the dramatic slowdown in the rate of decline of child mortality to only 4% in the 1978-1982 period. Rivero et al. (1991) also noted that others had observed similar effects in Brazil. ...
... Medical expenses and drugs are tax deductible In the three countries. The net resuit Is that the middle and upper classes are the only beneficiaries of this policy, since they are more likely to eam enough to pay taxes, and they consume the vast majority of the private health services (Cruz, et al. 1991). The lower middle class and some groups of the poor, live with low cash Income and utilize also the private health sern'ces, but have no means of recovering their expenditure. ...
... The problems of quaiity of care in hospital settings are more difficult to soive and have more severe consequences than those of the health centers or doctor's office. it has been documented that the cuts In the health sector occurred In many Latin American countries, affected the purchase of drugs and supplies and the level of salaries, but left largely untouched the scope, number and content of the existing health programs (Cruz, et al. 1991). Less money for medical supplies and equipment, maintenance, supervision, administration and salaries, have produced two effects: an improvement in the efficiency when there was a margin to do so, and a deterioration In the quaiity of care (Ayala, et al. 1991). ...
The authors focus on health policy issues associated with health reform needed to meet the health needs arising from the demographic and epidemiological transitions. They illustrate these policy issues by analyzing Brazil, Colombia, and Mexico, whose populations represent about 60 percent of Latin America's population. Brazil, Colombia, and Mexico are facing an important decline in mortality and fertility rates. New health problems have arisen related to rapid urbanization and industrialization - for example, injuries, accidental intoxication and poisoning, and the occupational and noncommunicable conditions (such as hypertension and diabetes) affecting an aging population. At the same time, these countries are not free of old health problems - such as infectious and parasitic diseases - although their mortality rates are declining. That is, old and new health problems coexist while wide social disparities persist in these developing Latin American countries. The epidemiological diversity and the speed of change in disease profiles makes the health transition in many developing countries more complex than the situation developed countries faced. Most of these countries also have inadequate health infrastructure and are unlikely to be able to afford to develop them in the next decade or so. Most governments are also being pressed to adopt the therapeutic medical model to deal with noncommunicable conditions. The authors arrive at the following seven conclusions about the implications of the epidemiological transition for health policy in developing Latin American countries. The transition offers an empirical framework for strategic planning for the health system, allowing policymakers to anticipate future trends and causes of mortality and anticipate disease scenarios. Since more disease is expected among the adult and elderly populations, the health system's mission should be revised with more emphasis on disease prevention and control and less on satisfying demand. Existing inequities in the geographical distribution of health resources and in the quality of care between health institutions should be corrected to avoid greater epidemiological polarization. The health care model should be reformed to strengthen the technical capacity to provide preventive and curative services at the first level of care to control the dual burden of disease. Efficiency and quality of care need to be substantially improved to accommodate the greater demand for clinical services, especially those provided at hospitals. Criteria for setting priorities in the health sector must be defined, so resources can be allocated among competing health needs and socioeconomic groups. These countries need to strengthen their ability to analyze the health status of populations, to evaluate the health system's performance, and to design cost-effective interventions to deal with noncommunicable diseases.
... That effect was apparent in the dramatic slow-down in the rate of decline of child mortality to only 4 % in the 1978-82 period. Rivero et al (1991) also noted that others had observed similar effects in Brazil. 2 (see Appendix) indicates a less dramatic but significant decline in social spending in HIPC countries during periods of increasing debt. Though health and education expenditure continued to increase as a proportion of (rapidly falling) total expenditure in the 1980-96 period, it actually fell relative to GDP in the late 1980s and only increased slowly thereafter. ...
An exploration of the use of appropriate technology in water management. A critical view of the development era. The creation of a new commons.
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