Health system reformers strive to achieve increased efficiency in the allocation of resources and equity in provision of services to meet peoples’ health care needs. Evidence from a comparative study of different types of health care systems in Mexico aims to inform health policy making in Latin America by helping to identify the most cost effective delivery systems, in particular for low-income groups. It is apparent that organisational reform of the sector may have a positive impact on overall performance.

Researchers with the Liverpool School of Tropical Medicine designed a study to compare two institutions providing health care to poor people in Mexico.  Alongside identifying the most cost effective institution, the study aimed to assess whethermerging or duplicating services may improve performance.

The two institutions are the Ministry of Health (MoH) and the Solidarity branch of the Social Security System (IMSS – OPRTUNIDADES).  Four states were chosen for the study, in which similar numbers of units from the MoH and IMSS-OP were operating, and in which both provided services free of charge.  Investigators conducted household surveys, interviews and focus group discussions in each of the four states, and distributed a satisfaction questionnaire to health workers in both institutions. 

The study populations in the catchment area of the two providers were very similar; only a minority subscribed to the pre-paid social security system.  The majority relied on free services.  More health care workers and hospital beds were available in the MoH areas, though geographical accessibility and waiting times were equally good in both groups. The MoH system had higher administration costs and a larger budget allocation for curative care, whilst the IMSS-OP allocated more resources for preventive services and staff training.  Overall, the costs per capita of target population were higher in the MoH system than in the IMSS-OP system.

The IMSS-OP system was shown to perform better on several indicators including the number of patients per physician per day, bed occupancy rate and length of hospital stay. The IMSS-OP also performed better in population coverage for immunization, family planning, antenatal care and access to free drugs, awareness of community participation activities and overall user satisfaction with the services provided.

Trends in morbidity and mortality from diarrhoeal diseases, acute respiratory infections, tuberculosis and typhoid fever indicate that water and sanitation is managed better in IMSS-OP areas than in MoH areas. Infant mortality rates showed similar tendencies, and maternal mortality rates remained stable in both systems.

Continuous supervision by direct visits from headquarters is more systematic in the IMSS-OP areas, where survey results also showed greater staff satisfaction with salary, bonuses, line manager support, supervision received and general working conditions.

From these findings it appears that:

• more efficient organisation of health service provision can make a difference to both staff performance and health outcomes
• in the case of Mexico, the political decision to integrate Social Services provision into the Ministry of Health system would lose important institutional experience and lessons learned in community health work
• health sector reforms across Latin America that have focused more on budget allocation than staff performance may be counter-productive.

Health policy-makers need access to the kind of information presented in this study. Although the necessary survey work takes time and needs resources, the benefits can provide a useful comparative insight into the performance of different health care delivery systems.

Source(s):
‘Health Service Analysis as a tool for evidence-based policy decisions: the case of the Ministry of Health and Social Security in Mexico’, Tropical Medicine and International Health 8(12): 1157-1164, by A. Kroeger and J.M. Hernandez, 2003
HINARI subscribers can access the full-text article here. Full document.

Funded by: CONACYT; British Council, Mexico

id21 Research Highlight: 26 May 2004

Further Information:
Axel Kroeger
World Health Organisation
Special Programme for Research and Training in Tropical Diseases (TDR) -
CDS/TDR/IDE
20, Avenue Appia
1211 Geneva 27
Switzerland

Tel: + 41 22 791 3398
Fax: + 41 22 791 4774
Contact the contributor: kroegera@who.int

Liverpool School of Tropical Medicine (LSTM), UK

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