Primary Health Care Utilization by the Mexican Indigenous Population: The Role of the Seguro Popular in Socially Inequitable Contexts

Flores, René Leyva; Serván‐Mori, Edson; Infante-Xibille, César; Pelcastre‐Villafuerte, Blanca Estela; González-Vázquez, Tonatiuh

doi:10.1371/journal.pone.0102781

Cited by 23 publications

(25 citation statements)

References 17 publications

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“…First, increasing health insurance ARR and physician density at PHC institutions were associated with more outpatient visits and admissions and more likelihood of visiting PHC institutions. Previous studies have found that introduction of PHC providers would lead to a shift of care from specialists to primary care for disease management in different settings [ 30 – 34 ]. In addition, studies in Sweden and Mexico have indicated that government financial investment in PHCs increased the number of visits to PHCs [ 12 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have found that introduction of PHC providers would lead to a shift of care from specialists to primary care for disease management in different settings [ 30 – 34 ]. In addition, studies in Sweden and Mexico have indicated that government financial investment in PHCs increased the number of visits to PHCs [ 12 , 35 ]. The majority of studies have focused on single policies (e.g.…”

Section: Discussionmentioning

confidence: 99%

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Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study

Jin

Zhu

et al. 2020

BMC Health Serv Res

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Background People bypass primary healthcare (PHC) institutions to seek expensive healthcare at high-level hospitals, leading to escalating medical costs and inefficient use of resources. In 2009, China launched nationwide synergic policies on primary care strengthening, to tackle access to healthcare and financial protection. This study aimed to assess the impact of the two policy areas, health insurance and health workforce, on healthcare seeking behavior. Methods Drawing on national survey data before (2008) and after (2013) the policies, we linked individual-level data on healthcare-seeking behavior with county-level data on health workforce and health insurance. We constructed a multilevel zero-inflated negative binomial regression to examine the impacts of average reimbursement rate (ARR) of health insurance and the density of registered physicians on outpatient/inpatient visits, and multilevel multinomial logistic regression for the impacts on choice of outpatient/inpatient care providers. Results Although the increase in health insurance ARR and physician density have positive impacts on individuals’ healthcare use, their impacts might be weakened during 2008 and 2013, and the negative impacts of investment of those in PHC institutions on likelihood of visiting hospitals was larger. The negative impacts of ARR at PHC institutions on likelihood of visiting county-, municipal- and higher-level hospitals in 2013 was 28 percentage points, 66 percentage points and 33 percentage points larger than these in 2008. Conclusions Primary care strengthening requires synergic policies. Effective mechanisms for coordination across multisectoral actions are necessities for deepening those policies to ensure efficient delivery of healthcare without experiencing financial risks.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study

Jin

Zhu

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

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“…16,30,31 In addition, studies in Sweden and Mexico have both indicated that government financial investment in PHCs can increase the number of visits to these facilities. 20,21 Second, the positive association between ARR at county hospitals and the probability of visiting those hospitals was stronger in areas with higher physician densities in the county hospitals. This finding has some implications for targeted health insurance improvement and health workforce allocation strategies.…”

Section: Discussionmentioning

confidence: 97%

“…17 While China's most recent health system reform was comprehensive, few studies have systematically quantified the impact of this reform on health care-seeking behaviour. The majority of studies in China and other developing countries have focused on individual health reform policies, such as reform of health insurance 4,5,[18][19][20][21] or investment in health workforce. 15,16 Several studies have assessed the effects of the health reform on health care access from a system-wide perspective; however, what is the relationship between specific health policies and health care-seeking behaviour is not examined.…”

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confidence: 99%

The interaction effect of health insurance reimbursement and health workforce on health care‐seeking behaviour in China

Jin

Yuan

Zhu

et al. 2019

Health Planning & Management

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Summary Objective In China, patients generally seek health care at high‐level hospitals, which is leading to escalating medical costs and overloaded hospitals. Some studies have suggested that the health system is an important factor influencing individuals' health care‐seeking behaviour; however, this association has not been studied in much depth. We therefore examined the impact of the health system (in terms of the interaction between health insurance reimbursement and health workforce) on health care‐seeking behaviour. Methods Drawing on national survey data from 2008 and 2013, we linked individual‐level data on choice of health care providers (our index of health care‐seeking behaviour) with county‐level data on the health workforce and health insurance. We then constructed a multilevel multinomial logistic model to examine the impacts of health insurance reimbursement (indexed as average reimbursement rate [ARR]) and the health workforce (number of registered physicians per 1000 population) at county hospitals and primary health care institutions (PHCs) on choice of inpatient care providers. Results Increases in ARR at county hospitals were associated with a greater probability of visiting such hospitals (relative risk ratio [RRR] = 1.23), and this positive impact was even greater in county hospitals with higher physician densities (RRR = 2.76). Greater ARR in PHCs was associated with a 73% lower probability of visiting municipal‐ and higher‐level hospitals; increasing ARR was associated with an even lower probability when physician density in PHCs was considered (RRR = 0.09). Conclusion Increases in the health insurance reimbursement and health workforce are necessary to improve health care access and thereby health care‐seeking behaviour. Thus, comprehensive health system reform is necessary.

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“…Leyva-Flores et al (2013) found that indigenous Mexicans’ health insurance coverage through the program Seguro Popular 1 rose from 14% in 2006 to 62% in 2012, and that their use of hospital services for childbirth increased from 64% to 76% during the same period. Although these are important health achievements, they have not been enough to close the inequalities between the indigenous and non-indigenous populations; rather, health disparities still persist in stunting, infant mortality, health insurance coverage, and health care utilization (Leyva-Flores, Servan-Mori, Infante-Xibille, Pelcastre-Villafuerte, & Gonzalez, 2014; Servan-Mori et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Internal migration and the health of Indigenous Mexicans: A longitudinal study

León-Pérez

2019

SSM - Population Health

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Rationale Indigenous peoples have historically comprised a substantial part of migration streams around the world, yet our understanding of the effects of migration on indigenous health is limited. Objective To explore the migration-indigenous health relationship by assessing the impact of internal migration on the self-rated health trajectories of indigenous Mexicans. Data and method Using three waves of data (2002–2012) from the Mexican Family Life Survey, I estimated linear growth curves to examine differences in initial self-rated health and changes in self-rated health between indigenous and non-indigenous respondents (N = 12,533). Then, I investigated whether migrating domestically during the study period shaped indigenous health trajectories. Results At the baseline interview (before migration), indigenous migrants reported significantly better self-rated health than indigenous non-migrants and than all non-indigenous respondents. In spite of their better initial health, indigenous migrants’ health deteriorated substantially after migration, such that by the time of the last interview they reported the worst health. The self-rated health of all other groups improved during the same period. Conclusion Findings provide evidence of pre-migration health selection and post-migration health deterioration among Mexican indigenous migrants. These results suggest that internal migration is a risk factor that has an independent effect on indigenous health even after adjusting for personal, family, socioeconomic, and health care factors.

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Primary Health Care Utilization by the Mexican Indigenous Population: The Role of the Seguro Popular in Socially Inequitable Contexts

Cited by 23 publications

References 17 publications

Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study

Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study

The interaction effect of health insurance reimbursement and health workforce on health care‐seeking behaviour in China

Internal migration and the health of Indigenous Mexicans: A longitudinal study

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