A Performance Analysis of Public Expenditure on Maternal Health in Mexico

Abstract

We explore the relationship between public expenditure, coverage of adequate ANC (including timing, frequent and content), and the maternal mortality ratio -adjusted by coverage of adequate ANC- observed in Mexico in 2012 at the State level. Additionally, we examine the inequalities and concentration of public expenditure between populations with and without Social Security. Results suggest that in the 2003–2011 period, the public expenditure gap between women with and without Social Security decreased 74%, however, the distribution is less equitable among women without Social Security, across the States. Despite high levels of coverage on each dimension of ANC explored, coverage of adequate ANC was lower among Social Security than non-Social Security women. This variability results in differences up to 1.5 times in State-adjusted maternal mortality rate at the same level of expense and maternal mortality rate, respectively. The increase in the economic resources is only a necessary condition for achieving improved health outcomes. Providing adequate health services and achieving efficient, effective and transparent use of resources in health, are critical elements for health systems performance. The attainment of universal effective coverage of maternal health and reducing maternal mortality in Mexico, requires the adjustment of policy innovations including the rules of allocation and execution of health resources. Health policies should be designed on a more holistic view promoting a balance between accessibility, effective implementation and rigorous stewardship.

Government expenditure on health and maternal mortality in México: A spatial‐econometric analysis

“…On average, the elasticity of MM severity‐GE was −4% ( P < 0.01). However, in those municipalities suffering from the worst structural conditions and from the highest levels of social vulnerability (ie, greater social marginalization, a higher proportion of indigenous people, and less availability of health resources and public services such as potable water and roads), this association was negligible, finding that is consistent with previous reports . Our results therefore suggest a spatial misalignment between increased resources and maternal health care requirements in México at the municipal level.…”

“…Excluded from analysis were municipalities created after 2000 ( n = 14) as well as those without full information in the indicators used to control for the relationship of interest ( n = 185), such as rurality, marginalization, the presence of indigenous population; female schooling; fertility; age structure of the female population; available human and material health care resources; profile of women who died from maternal causes (socio‐demographic characteristics and health care received); and timeliness and frequency of antenatal health care coverage at the municipal level (see details in Table ). The final sample of municipalities analyzed came to 2258 (92% of the total number of municipalities in México).…”

“…The SP has sought close coordination with specific maternal health programs committed to reducing MM, namely the Fair Start in Life Program and various inter‐institutional agreements (ie, the Healthy Pregnancy Strategy, and the General Agreement on Inter‐Institutional Collaboration for Emergency Obstetric Health Care, both established in 2008). Funds were allocated to finance these actions so maternal health expenditure increased 2.5 times between 2003 and 2014 .…”

“…Taking the foregoing into account, our study formulated its analytical strategy on the following bases: data were confined to GE for the population without Social Security coverage and were drawn from the Reproductive Health and Gender Equality Accounts for the period 2003 to 2014; the GE‐MM relationship was estimated for the 2457 Mexican municipalities using Heckman self‐selection bias correction combined with spatial econometric analyses that explicitly incorporated the aforementioned self‐selection problem and non‐random territoriality in the expenditure patterns, health investment, and MM in México …”

A spatio‐temporal cluster analysis of technical efficiency in the production of outpatient maternal health services and its structural correlates in México

“…Furthermore, SP enrollment has increased access to health care for women with lower schooling, reducing their risk for preterm birth . On the negative side, however, it has been noted that service production varies significantly among states with comparable public expenditure, particularly as regards to the delivery of opportune and frequent antenatal care with adequate content . Also, disparities exist in the provision of adequate maternal care coverage according to geographic location and socioeconomic status .…”