Mauricio Hernández Avila

Public Policy for the Poor? A Randomised Assessment of the Mexican Universal Health Insurance Programme

BACKGROUND We assessed aspects of Seguro Popular, a programme aimed to deliver health insurance, regular and preventive medical care, medicines, and health facilities to 50 million uninsured Mexicans. METHODS We randomly assigned treatment within 74 matched pairs of health clusters-ie, health facility catchment areas-representing 118 569 households in seven Mexican states, and measured outcomes in a 2005 baseline survey (August, 2005, to September, 2005) and follow-up survey 10 months later (July, 2006, to August, 2006) in 50 pairs (n=32 515). The treatment consisted of encouragement to enrol in a health-insurance programme and upgraded medical facilities. Participant states also received funds to improve health facilities and to provide medications for services in treated clusters. We estimated intention to treat and complier average causal effects non-parametrically. FINDINGS Intention-to-treat estimates indicated a 23% reduction from baseline in catastrophic expenditures (1.9% points; 95% CI 0.14-3.66). The effect in poor households was 3.0% points (0.46-5.54) and in experimental compliers was 6.5% points (1.65-11.28), 30% and 59% reductions, respectively. The intention-to-treat effect on health spending in poor households was 426 pesos (39-812), and the complier average causal effect was 915 pesos (147-1684). Contrary to expectations and previous observational research, we found no effects on medication spending, health outcomes, or utilisation. INTERPRETATION Programme resources reached the poor. However, the programme did not show some other effects, possibly due to the short duration of treatment (10 months). Although Seguro Popular seems to be successful at this early stage, further experiments and follow-up studies, with longer assessment periods, are needed to ascertain the long-term effects of the programme.

Cervical Cancer Screening in Developing Countries: Why Is It Ineffective? The Case of Mexico

BACKGROUND Mexico established a national cervical cancer-screening program in 1974. Despite the implementation of the program, there was a steady mortality trend of 16 per 100,000 women over 15 years. METHODS A diagnostic procedure of the pitfalls was applied to the following steps of the screening procedure: Pap sampling quality; cytological diagnosis validity; compliance of women; and determinants of non-participation. RESULTS The low effectiveness of screening on cervical cancer is principally due to factors associated with quality and coverage. Pap quality is deficient; 64% of a random sample of specimens lacked endocervical cells. Reading centers presented false negative indices of between 10 and 54%. Women seek screening in a late stage of disease (55% with cervical cancer seek care because they have symptoms). In addition, coverage is low; in women between 15 and 49 years of age in Mexico City, 64.2% have a history of Pap, compared with 30% in rural areas. Knowledge of what the Pap is used for strongly determines the use of screening. In rural areas, only 40% of women are informed about the purpose of the Pap test. CONCLUSIONS A proposal to reorganize Mexicos screening program includes the following five main strategies: (a) increased coverage; (b) improved quality control of how cervical smears are taken; (c) better interpretation of Pap tests; (d) guaranteed treatment for those whose tests show abnormalities, and (e) improved follow-up.

Costos directos de atención médica en pacientes con diabetes mellitus tipo 2 en México: análisis de microcosteo

OBJETIVO: Estimar los costos directos de la atencion medica a pacientes con diabetes mellitus tipo 2 (DM2) en el Instituto Mexicano del Seguro Social (IMSS). METODOS: Se revisaron expedientes clinicos de 497 pacientes que ingresaron a unidades de segundo y tercer nivel de atencion durante el periodo 2002-2004. Los costos se cuantificaron utilizando el enfoque de costeo de enfermedad (CDE) desde la perspectiva del proveedor, la tecnica del microcosteo y la metodologia de abajo-arriba (bottom-up). Se estimaron costos promedio anuales de diagnostico, por complicacion y total de la enfermedad. RESULTADOS: El costo total anual de los pacientes con DM2 para el IMSS fue de US

Breast cancer in Mexican women: an epidemiological study with cervical cancer control

452 064 988, correspondiente a 3,1% del gasto de operacion. El costo promedio anual por paciente fue de US

Evaluation of indoor ozone concentration and predictors of indoor-outdoor ratio in Mexico City

3 193,75, correspondiendo US

Intervention Research Needs for Aids Prevention Among Commercial Sex Workers and Their Clients

2 740,34 para el paciente sin complicaciones y US

The art of public health: pneumococcal vaccine coverage in Mexico

3 550,17 para el paciente con complicaciones. Los dias/cama en hospitalizacion y en unidad de cuidados intensivos fueron los servicios con mayor costo. CONCLUSIONES: Los elevados costos en la atencion medica a pacientes con DM2 y complicaciones representan una carga economica que las instituciones de salud deben considerar en su presupuesto, a fin de poder brindar un servicio de calidad, adecuado y oportuno. El empleo de la metodologia de microcosteo permite un acercamiento a datos reales de utilizacion y manejo de la enfermedad

El consumo de tabaco en la Región Americana: elementos para un programa de acción

INTRODUCTION In Mexico, breast cancer (BC) is one of the main causes of cancer deaths in women, with increasing incidence and mortality in recent years. Therefore, the aim of the study is identify possible risk factors related to BC. METHODS An epidemiological study of hospital cases of BC and controls with cervical uterine cancer (CUCA) was carried out at eight third level concentration hospitals in Mexico City. The total of 353 incident cases of BC and 630 controls with CUCA were identified among women younger than 75 years who had been residents of the metropolitan area of Mexico City for at least one year. Diagnosis was confirmed histologically in both groups. Variables were analyzed according to biological and statistical plausibility criteria. Univariate, bivariate and multivariate analyses were carried out. Cases and controls were stratified according to the menopausal hormonal status (pre and post menopause). RESULTS The factors associated with BC were: higher socioeconomic level (OR= 2.77; 95%CI = 1.77 - 4.35); early menarche (OR= 1.32; 95%CI= 0.88 - 2.00); old age at first pregnancy (>31 years: OR= 5.49; 95%CI= 2.16 - 13.98) and a family history of BC (OR= 4.76; 95% CI= 2.10 - 10.79). In contrast, an increase in the duration of the breastfeeding period was a protective factor (>25 months: OR= 0.38; 95%CI= 0.20 - 0.70). CONCLUSIONS This study contributes to the identification of risk factors for BC described in the international literature, in the population of Mexican women. Breastfeeding appears to play an important role in protecting women from BC. Because of changes in womens lifestyles, lactation is decreasing in Mexico, and young women tend not to breastfeed or to shorten the duration of lactation.

Proposal to institutionalize criteria and quality standards for cervical cancer screening within a health care system

ABSTRACT As part of a study on the potential adverse health effects of ozone exposure on the respiratory health of young children residing in Mexico City, we used passive ozone monitoring devices to determine microenvironmental ozone concentrations. Indoor and outdoor ozone concentrations were measured at 145 homes and at the schools of participating children. In addition, outdoor concentrations were also measured with continuous monitors at the schools and at stationary outdoor monitoring sites. At the childrens homes, indoor ozone levels were 1030% of the outdoor ozone concentrations. The mean indoor-to-outdoor (I/O) ratio was 0.20 (SD = 0.18). The highest I/O ratios were observed in homes where windows were usually open during the day, and where there was carpeting or air filters. At school during class hours, the I/O ratio was higher (0.3 to 0.4) than at the childrens homes, due to periodic opening of the doors and windows. Given the large disparity in ozone concentrations between different microenv...

Análisis costo beneficio del programa de detección oportuna del cáncer cervicouterino

Given the absence of an effective vaccine against HIV infection, and the lack of effective and affordable therapies to mitigate disease progression in most high-prevalence countries, preventing further escalation of HIV/AIDS morbidity and mortality must focus primarily on educational interventions to reduce transmission of HIV. Responding to this challenge has created a wider awareness in public health circles that educational interventions are just as technically and operationally challenging to conceive, execute, and evaluate as are biomedical or environmental interventions to control disease.