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

Abstract

Summary Objective To assess the relationship between government expenditure on maternal health (GE) and maternal mortality (MM) in Mexican poor population between 2000 and 2015 in the 2457 Mexican municipalities. Methods Using administrative data, we performed the analysis in three stages: First, we tested the presence of selection bias in MM. Next, we assessed the presence of spatial dependence in the incidence and severity of MM. Finally, we estimated a spatial error model considering the correction of estimates for the spatial dependence and selection bias assessed before. Results MM and GE were not randomly distributed throughout the Mexican territory; the most socially vulnerable municipalities exhibited the highest levels of MM severity but the lowest levels of GE and available human and physical resources for maternal health; the incidence of MM was independent of GE; elasticity of GE‐severity in MM was −4% (P < 0.01). Conclusions Resource allocation for maternal health must move towards a more comprehensive vision, and efforts to achieve an effective delivery of universal health services must improve, particularly regarding the most vulnerable municipalities.

Ethnic inequalities in health intervention coverage among Mexican women at the individual and municipality levels

“…Inequalities experienced by indigenous women and communities are intimately associated with prevailing socioeconomic conditions [30] . Our results confirm that municipalities with higher proportions of indigenous people tend to be poorer and less well served by health services than other municipalities [11 , 12 , 31] . At individual level, indigenous women are poorer, less educated, and have less access to services than non-indigenous women, also have a higher proportion of people living in poverty.…”

Government Expenditure on Maternal Health and Family Planning Services for Adolescents in Mexico, 2003–2015

“…Although government MHFP spending has increased across the board nationally, discrepancies persist in its distribution among states, since those with similar adolescent populations in need of MH and FP services exhibit different levels of expenditure. This could be the result of various factors, such as the persistence of inertial allocations: (a) in 2015, 33% of the Seguro Popular budget earmarked for payroll continued to be allocated to State Health Services on the basis of long-established, routine procedures [39]; (b) the concentration of infrastructure and personnel have traditionally privileged some states at the expense of others; and (c) managerial capacities have diverged and continue to vary widely among State Health Services [17,48,50].…”

“…In addition, it has been documented that pregnant women under 15 register their children with the appropriate authorities later than other women [54]. (4) Finally, it should be noted that expenditure was analyzed at the state level, without considering the wide variability in the distribution of local spending [17,50]. Future studies need to explore in greater detail the relationship among MHFP resources, as well as their distribution and health outcomes at the municipal level.…”

Lags in the provision of obstetric services to indigenous women and their implications for universal access to health care in Mexico

“…On the one hand, it developed a universal coverage strategy based on the expansion of public insurance, which provided funding to both health centres and hospitals to encourage the responsiveness of medical services in the health care system. 16 In addition, the Ministry of Health promoted a patient-centred care model, fostering a respectful regard for the reproductive rights of users. This model was supported by the National Centre for Gender Equity and Reproductive Health, a federal agency responsible for promoting good practices in pregnancy, childbirth and postnatal care.…”