Juan José Díaz

Health care utilization among older mexicans: health and socioeconomic inequalities

OBJECTIVE 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. MATERIAL AND METHODS Data was used from the 2001 Mexican Health and Aging Study (MHAS/ENASEM) and estimates were made using multivariate probit regression methods. RESULTS 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. CONCLUSION 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.

Household catastrophic health expenditures: A comparative analysis of twelve Latin American and Caribbean Countries

OBJECTIVE Compare patterns of catastrophic health expenditures in 12 countries in Latin America and the Caribbean. MATERIAL AND METHODS Prevalence of catastrophic expenses was estimated uniformly at the household level using household surveys. Two types of prevalence indicators were used based on out-of-pocket health expense: a) relative to an international poverty line, and b) relative to the households ability to pay net of their food basket. Ratios of catastrophic expenditures were estimated across subgroups defined by economic and social variables. RESULTS The percent of households with catastrophic health expenditures ranged from 1 to 25% in the twelve countries. In general, rural residence, lowest quintile of income, presence of older adults, and lack of health insurance in the household are associated with higher propensity of catastrophic health expenditures. However, there is vast heterogeneity by country. CONCLUSIONS Cross national studies may serve to examine how health systems contribute to the social protection of Latin American households.

Health Care Use Among Elderly Mexicans in the United States and Mexico The Role of Health Insurance

The authors sought to contribute to public policy on U.S. immigrants by comparing patterns of health care use among the Mexican-origin population aged 70 and older in the United States and Mexico. They studied the role of health insurance in the propensity to have doctor visits and hospitalizations, controlling for aspects of health and the economic and sociodemographic characteristics of individuals. The authors found that the elderly of Mexican origin in the United States were more likely to be hospitalized than those in Mexico, regardless of health insurance. However, in the absence of health insurance, visits to doctors were more likely in Mexico than in the United States. The results indicate that although in both countries, the availability of health insurance is associated with a higher propensity to use any health care services, a lack of health insurance may have more negative consequences for primary health care in the United States than in Mexico.

Evaluating interventions to reduce maternal mortality: evidence from Peru's PARSalud programme

This paper evaluates the impact of an intervention oriented to reduce maternal mortality in Peru. The paper takes advantage of both spatial and temporal variation in the implementation of the programme to identify its effects. Results suggest a positive impact of the training provided by the programme on the number of deliveries, deliveries using oxytocin, caesarean deliveries, and complicated deliveries, but ambiguous effects of infrastructure investments. Moreover, different types of training had different impacts, internships on perinatal technologies having larger impacts. No effects are found on obstetric complications, but there are positive effects on the number of complicated deliveries attended. Results also show that the programme reduces the incidence of postpartum haemorrhage, the main cause of maternal mortality. As far as cost-effectiveness is concerned, the cost of averting a case of postpartum haemorrhage is about US

Perfil situacional y estrategias de intervención en la región mesoamericana en el área de salud materna, reproductiva y neonatal

3328, compared with the present discounted value of the per-capita Gross Domestic Product over a lifespan of 45 extra years of life – about US

La investigación sobre el mercado laboral peruano: instituciones, capacitación y grupos desfavorecidos

36,700.

Guía para la elaboración de una línea de base de la minería a pequeña escala

Presentar los principales resultados del diagnostico situacional y plan regional de intervenciones en salud materna, reproductiva y neonatal elaborado como parte de los trabajos del Sistema Mesoamericano de Salud por el grupo de salud materna, reproductiva y neonatal (SMRN) en 2010. Se conformo un grupo de expertos y de representantes de los paises de la region (que incluye Centroamerica y nueve estados del sur de Mexico). Se hizo una revision documental para conformar un diagnostico situacional, una revision de practicas efectivas y se conformo un plan regional de accion. El diagnostico situacional indica que las tasas de mortalidad materna y neonatal se mantienen inaceptablemente altas en la region. Se propuso como meta regional reducir la mortalidad materna y neonatal de acuerdo a los Objetivos de Desarrollo del Milenio. Se conformo un plan regional que identifica intervenciones especificas en SMRN con enfasis en la atencion adecuada a las emergencias obstetricas y neonatales, atencion calificada al nacimiento, y en planificacion familiar. Se sugiere asimismo un plan de implementacion a cinco anos y una estrategia de evaluacion y de capacitacion. El plan regional en SMRN puede tener exito siempre y cuando los aspectos de implementacion sean atendidos debidamente.