Since 2001, Mexico has been designing, legislating, and implementing a major health-system reform. A key component was the creation of
Seguro Popular, which is intended to expand insurance coverage ...over 7 years to uninsured people, nearly half the total population at the start of 2001. The reform included five actions: legislation of entitlement per family affiliated which, with full implementation, will increase public spending on health by 0·8–1·0% of gross domestic product; creation of explicit benefits packages; allocation of monies to decentralised state ministries of health in proportion to number of families affiliated; division of federal resources flowing to states into separate funds for personal and non-personal health services; and creation of a fund to protect families against catastrophic health expenditures. Using the WHO health-systems framework, we used a wide range of datasets to assess the effect of this reform on different dimensions of the health system. Key findings include: affiliation is preferentially reaching the poor and the marginalised communities; federal non-social security expenditure in real per-head terms increased by 38% from 2000 to 2005; equity of public-health expenditure across states improved;
Seguro Popular affiliates used more inpatient and outpatient services than uninsured people; effective coverage of 11 interventions has improved between 2000 and 2005–06; inequalities in effective coverage across states and wealth deciles has decreased over this period; catastrophic expenditures for
Seguro Popular affiliates are lower than for uninsured people even though use of services has increased. We present some lessons for Mexico based on this interim evaluation and explore implications for other countries considering health reforms.
Benchmarking of the performance of states, provinces, or districts in a decentralised health system is important for fostering of accountability, monitoring of progress, identification of ...determinants of success and failure, and creation of a culture of evidence. The Mexican Ministry of Health has, since 2001, used a benchmarking approach based on the WHO concept of effective coverage of an intervention, which is defined as the proportion of potential health gain that could be delivered by the health system to that which is actually delivered. Using data collection systems, including state representative examination surveys, vital registration, and hospital discharge registries, we have monitored the delivery of 14 interventions for 2005-06. Overall effective coverage ranges from 54.0% in Chiapas, a poor state, to 65.1% in the Federal District. Effective coverage for maternal and child health interventions is substantially higher than that for interventions that target other health prohlems. Effective coverage for the lowest wealth quintile is 52% compared with 61% for the highest quintile. Effective coverage is closely related to public-health spending per head across slates; this relation is stronger for interventions that are not related to maternal and child health than those for maternal and child health. Considerable variation also exists in efiective coverage at similar amounts of spending. We discuss the implications of these issues for the further development of the Mexican health-information system. Benchmarking of performance by measuring effective coverage encourages decision-makers to focus on quality service provision, not only service availability. The effective coverage calculation is an important device for health-system stewardship. In adopting this approach, other countries should select interventions to he measured on the basis of the criteria of affordability, effect on population health, effect on health inequalities, and capacity to measure the effects of the intervention. The national institutions undertaking this benchmarking must have the mandate, skills, resources, and independence to succeed. PUBLICATION ABSTRACT
Benchmarking of the performance of states, provinces, or districts in a decentralised health system is important for fostering of accountability, monitoring of progress, identification of ...determinants of success and failure, and creation of a culture of evidence. The Mexican Ministry of Health has, since 2001, used a benchmarking approach based on the WHO concept of effective coverage of an intervention, which is defined as the proportion of potential health gain that could be delivered by the health system to that which is actually delivered. Using data collection systems, including state representative examination surveys, vital registration, and hospital discharge registries, we have monitored the delivery of 14 interventions for 2005–06. Overall effective coverage ranges from 54·0% in Chiapas, a poor state, to 65·1% in the Federal District. Effective coverage for maternal and child health interventions is substantially higher than that for interventions that target other health problems. Effective coverage for the lowest wealth quintile is 52% compared with 61% for the highest quintile. Effective coverage is closely related to public-health spending per head across states; this relation is stronger for interventions that are not related to maternal and child health than those for maternal and child health. Considerable variation also exists in effective coverage at similar amounts of spending. We discuss the implications of these issues for the further development of the Mexican health-information system. Benchmarking of performance by measuring effective coverage encourages decision-makers to focus on quality service provision, not only service availability. The effective coverage calculation is an important device for health-system stewardship. In adopting this approach, other countries should select interventions to be measured on the basis of the criteria of affordability, effect on population health, effect on health inequalities, and capacity to measure the effects of the intervention. The national institutions undertaking this benchmarking must have the mandate, skills, resources, and independence to succeed.
Since 2001, Mexico has been designing, legislating, and implementing a major health-system reform. A key component was the creation of Seguro Popular, which is intended to expand insurance coverage ...over 7 years to uninsured people, nearly half the total population at the start of 2001. The reform included five actions: legislation of entitlement per family affiliated which, with full implementation, will increase public spending on health by 0.8-1.0% of gross domestic product; creation of explicit benefits packages; allocation of monies to decentralised state ministries of health in proportion to number of families affiliated; division of federal resources flowing to states into separate funds for personal and non-personal health services; and creation of a fund to protect families against catastrophic health expenditures. Using the WHO health-systems framework, we used a wide range of datasets to assess the effect of this reform on different dimensions of the health system. Key findings include: affiliation is preferentially reaching the poor and the marginalised communities; federal non-social security expenditure in real per-head terms increased in 38% from 2000 to 2005; equity of public-health expenditure across states improved; Seguro Popular affiliates used more inpatient and outpatient services than uninsured people; effective coverage of 11 interventions has improved between 2000 and 2005-06; inequalities in effective coverage across states and wealth deciles has decreased over this period; catastrophic expenditures for Seguro Popular affiliates are lower than for uninsured people even though use of services has increased. We present some lessons for Mexico based on this interim evaluation and explore implications for other countries considering health reforms. PUBLICATION ABSTRACT
White locoweed (Oxytropis sericea Nuttall) and nontarget vegetation response to 2 yr of targeted grazing by sheep, one treatment of picloram plus 2, 4-D (HER) or no treatment (CON) were compared. ...Serum of sheep that grazed locoweed intermittently (IGZ, 5 d on locoweed followed by 3 d off locoweed) vs. counterparts that grazed locoweed continuously for 24 d (CGZ) was also examined. Alkaloid toxicity was inferred by serum levels of thyroxine (T4), triiodothyronine (T3), alkaline phosphatase (ALKP), aspartate aminotransferase (AST), and swainsonine, as well as behavior and body weight gains. Three sites were used in a randomized complete block design. IGZ, CGZ, and HER treatments reduced locoweed density (P < 0.01), canopy cover (P < 0.01), number of flower stalks (IGZ: P = 0.02, CGZ and HER: P = 0.01), and plant size (P < 0.01). White locoweed seed density in the soil seed bank was not reduced with grazing, and nontarget vegetation was mostly unaffected by treatments. Grass canopy cover increased in grazed and herbicide plots throughout the study (IGZ: P = 0.03, CGZ and HER: P < 0.01). Percentage bare ground was unchanged (IGZ: P = 0.46, CGZ: P = 0.44) in grazed plots but decreased (P = 0.03) in HER plots. After 24 d, ewes in the IGZ treatment had lower levels of serum ALKP (P < 0.01) and AST (P = 0.02) and marginally lower swainsonine levels (P < 0.07) than CGZ ewes that tended to exhibit lower serum T3 (P < 0.07) and similar serum T4 (P = 0.25) levels. Time spent feeding on locoweed tended to differ (P = 0.06) between treatments. Body weight gain was the same (P = 0.19) regardless of treatment. IGZ of locoweed-infested rangeland with sheep may be a viable short-term means of reducing locoweed density without detrimentally affecting animal health.
Benchmarking of the performance of states, provinces, or districts in a decentralised health system is important for fostering of accountability, monitoring of progress, identification of ...determinants of success and failure, and creation of a culture of evidence. The Mexican Ministry of Health has, since 2001, used a benchmarking approach based on the World Health Organization (WHO) concept of effective coverage of an intervention, which is defined as the proportion of potential health gain that could be delivered by the health system to that which is actually delivered. Using data collection systems, including state representative examination surveys, vital registration, and hospital discharge registries, we have monitored the delivery of 14 interventions for 2005-06. Overall effective coverage ranges from 54.0% in Chiapas, a poor state, to 65.1% in the Federal District. Effective coverage for maternal and child health interventions is substantially higher than that for interventions that target other health problems. Effective coverage for the lowest wealth quintile is 52% compared with 61% for the highest quintile. Effective coverage is closely related to public-health spending per head across states; this relation is stronger for interventions that are not related to maternal and child health than those for maternal and child health. Considerable variation also exists in effective coverage at similar amounts of spending. We discuss the implications of these issues for the further development of the Mexican health-information system. Benchmarking of performance by measuring effective coverage encourages decision-makers to focus on quality service provision, not only service availability. The effective coverage calculation is an important device for health-system stewardship. In adopting this approach, other countries should select interventions to be measured on the basis of the criteria of affordability, effect on population health, effect on health inequalities, and capacity to measure the effects of the intervention. The national institutions undertaking this benchmarking must have the mandate, skills, resources, and independence to succeed.
Realizar un análisis comparativo del desempeño (benchmarking)
de las unidades subnacionales en un sistema de salud
descentralizado es importante para favorecer la rendición
de cuentas, monitorear el ...progreso, identificar los factores
que determinan tanto el éxito como el fracaso, y crear una
cultura basada en la evidencia. Desde 2001, la Secretaría de
Salud de México se ha dedicado a desarrollar esta tarea
basándose en el concepto de cobertura efectiva promovido
por la Organización Mundial de la Salud (OMS), que la
define como la fracción de ganancia potencial en salud que
el sistema de salud podría aportar, con los servicios que actualmente
ofrece. Usando los sistemas de información en
salud, que incluyen encuestas de salud representativas a nivel
estado, registros vitales y registros de egresos hospitalarios,
se ha monitoreado la prestación de 14 intervenciones
para mejorar la salud entre 2005 y 2006. La cobertura efectiva
en general va desde 54% en Chiapas hasta 65% en el
Distrito Federal. La cobertura efectiva para intervenciones
en salud materno-infantil es mayor que para las intervenciones
que abordan otros problemas de salud del adulto. La
cobertura efectiva para el quintil de ingresos más bajo es
de 52%, comparada con 61% para el quintil de ingresos más
alto. La cobertura efectiva guarda especial relación con el
gasto público en salud per cápita en todos los estados, y
esta relación es más estrecha con las intervenciones ajenas
a la salud materno-infantil que con las que tienen que ver directamente con ella. También se observan variaciones considerables
en la cobertura efectiva en niveles de gasto similares.
Asimismo, se discuten algunas implicaciones para el
desarrollo que debiera seguir el sistema de información en
salud en México. Este enfoque alienta a quienes toman decisiones
a concentrarse en brindar servicios de calidad y no
sólo en ofrecer la disponibilidad del servicio. El cálculo de la
cobertura efectiva es una herramienta clave para la rectoría
del sistema de salud. Al adoptar este enfoque, otros países
podrán elegir intervenciones con base en criterios de accesibilidad,
efecto en la salud de la población, efecto en desigualdades
de salud y en la capacidad para medir dichos efectos.
Para alcanzar el éxito en este tipo de análisis comparativo
del desempeño a nivel subnacional, las instituciones nacionales
que lo lleven a cabo deberán contar con autoridad,
habilidades técnicas, recursos e independencia suficientes.
Since 2001, Mexico has been designing, legislating, and implementing a major health-system reform. A key component was the creation of Seguro Popular, which is intended to expand insurance coverage ...over seven years to uninsured people, nearly half the total population at the start of 2001. The reform included five actions: legislation of entitlement per family affiliated which, with full implementation, will increase public spending on health by 0.8-1.0% of gross domestic product; creation of explicit benefits packages; allocation of monies to decentralised state ministries of health in proportion to number of families affiliated; division of federal resources flowing to states into separate funds for personal and non-personal health services; and creation of a fund to protect families against catastrophic health expenditures. Using the WHO health-systems framework, a wide range of datasets to assess the effect of this reform on different dimensions of the health system was used. Key findings include: affiliation is preferentially reaching the poor and the marginalised communities; federal non-social security expenditure in real per-head terms increased by 38% from 2000 to 2005; equity of public-health expenditure across states improved; Seguro Popular affilates used more inpatient and outpatient services than uninsured people; effective coverage of 11 interventions has improved between 2000 and 2005-06; inequalities in effective coverage across states and wealth deciles has decreased over this period; catastrophic expenditures for Seguro Popular affiliates are lower than for uninsured people even though use of services has increased. We present some lessons for Mexico based on this interim evaluation and explore implications for other countries considering health reforms.
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