RESUMEN
Limited research has examined barriers to sexual and reproductive health (SRH) services for Mexican immigrant women, especially those living in the eastern United States. This mixed-method study describes SRH care utilization and barriers experienced by female Mexican immigrants living in New York City. One hundred and fifty-one women completed surveys, and twenty-three also participated in focus groups. Usage of SRH care was low apart from prenatal services. The highest barriers included cost, language differences, child care, and poor service quality. After adjusting for insurance status, barriers were associated with receipt of gynecological care from a clinic or private doctor. Greater SRH knowledge was associated with current contraceptive use and a recent PAP test. Women reported that promotoras could increase information about SRH and decrease barriers. Results suggest that in a context where services are geographically available, health care utilization is impacted by lack of knowledge and structural barriers such as language, cost, and child care. Implications for community outreach are discussed.
Asunto(s)
Emigrantes e Inmigrantes , Americanos Mexicanos , Servicios de Salud Reproductiva/estadística & datos numéricos , Adulto , Niño , Cuidado del Niño , Barreras de Comunicación , Femenino , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud , Humanos , Ciudad de Nueva York , Calidad de la Atención de Salud , Servicios de Salud Reproductiva/economíaRESUMEN
This study presents findings from a systematic review of the evidence regarding the effectiveness of youth centers in increasing use of sexual and reproductive health (SRH) services in lower- and middle-income countries. Evidence from peer-reviewed and gray literature between 1990 and 2010 was reviewed. After the screening of 3,769 citations, 21 studies reporting on 17 youth center programs were included, and were ranked by strength of evidence. Considerable consistency in findings across studies was observed. Youth centers generally served a relatively small proportion of young people living nearby. The main users were young men attending school or college, with a significant proportion older than the target age. Users of the on-site SRH services were predominantly young women, with a significant proportion older than the target age group. Uptake of services was generally low. Despite widespread emphasis on youth centers as a strategy for encouraging young people to access SRH services, results from these studies have not been encouraging, and cost-effectiveness for these purposes is likely to be low.
Asunto(s)
Servicios de Salud del Adolescente/organización & administración , Servicios de Salud Comunitaria/organización & administración , Servicios de Salud Reproductiva/organización & administración , Educación Sexual/organización & administración , Adolescente , Servicios de Salud del Adolescente/economía , Adulto , África del Sur del Sahara , Niño , Servicios de Salud Comunitaria/economía , Análisis Costo-Beneficio , Femenino , Guatemala , Humanos , Masculino , Servicios de Salud Reproductiva/economía , Educación Sexual/economía , Conducta Sexual , Factores Socioeconómicos , Trinidad y Tobago , Adulto JovenRESUMEN
CONTEXT: Guatemala has some of the poorest reproductive health indices and largest disparities in health in Latin America, particularly between indigenous and ladina women. To reduce these disparities, it is necessary to understand how indigenous women's disadvantages in linguistic, socioeconomic or residential characteristics relate to their underutilization of reproductive health services. METHODS: Logistic regression analyses of a nationally representative sample of women aged 15-49 from the 2008-2009 National Survey of Maternal and Infant Health were used to estimate ethnic disparities in women's use of institutional prenatal care and delivery, and in met demand for modern contraceptives. Using predicted probabilities, we estimated the extent to which these disparities were attributable to a language barrier among indigenous women and to their disadvantage in selected socioeconomic and residential characteristics. RESULTS: The ethnic difference in use of institutional prenatal care was small; however, institutional delivery was far less common among indigenous women than among ladina women (36% vs. 73%), as was met need for modern contraceptives (49% vs. 72%). Not speaking Spanish accounted for the largest portion of these ethnic differentials. Indigenous women's poor education and rural residence made up smaller portions of the ethnic differential in modern contraceptive use than did their economic disadvantage. CONCLUSION: The large proportion of indigenous women who use institutional prenatal care suggests that further integrating the three services may increase their use of institutional delivery and modern contraceptives. Adding speakers of local Mayan languages to the staff of health facilities could also help increase use.
Asunto(s)
Parto Obstétrico/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Atención Prenatal/estadística & datos numéricos , Servicios de Salud Reproductiva/estadística & datos numéricos , Adolescente , Adulto , Tasa de Natalidad/etnología , Barreras de Comunicación , Anticoncepción/economía , Anticoncepción/estadística & datos numéricos , Parto Obstétrico/economía , Escolaridad , Femenino , Guatemala , Encuestas de Atención de la Salud , Disparidades en Atención de Salud/economía , Humanos , Indígenas Centroamericanos/estadística & datos numéricos , Modelos Logísticos , Persona de Mediana Edad , Pobreza , Atención Prenatal/economía , Servicios de Salud Reproductiva/economía , Salud Rural , Adulto JovenRESUMEN
OBJECTIVE: Present and analyze cost-effectiveness information of public health interventions proposed by the Mesoamerican Health Initiative in child nutrition, vaccination, malaria, dengue, and maternal, neonatal, and reproductive health. MATERIAL AND METHODS: A systematic literature review was conducted on cost-effectiveness studies published between January 2000 and August 2009 on interventions related to the health areas previously mentioned. Studies were included if they measured effectiveness in terms of Disability-Adjusted Life Year (DALY) or death averted. RESULTS: Child nutrition and maternal and neonatal health interventions were found to be highly cost-effective (most of them below US$200 per DALY averted for nutritional interventions and US$100 for maternal and neonatal health). For dengue, information on cost-effectiveness was found just for application of larvicides, which resulted in a cost per DALY averted ranking from US$40.79 to US$345.06. Malarial interventions were found to be cost-effective (below US$150 per DALY averted or US$4,000 per death averted within Africa). In the case of pneumococcus and rotavirus vaccination, cost-effectiveness estimates were always above one GDP per capita per DALY averted. CONCLUSIONS: In Mesoamerica there are still important challenges in child nutrition, vaccination, malaria, dengue and maternal, neonatal, and reproductive health, challenges that could be addressed by scaling-up technically feasible and cost-effective interventions.
Asunto(s)
Bibliometría , Análisis Costo-Beneficio/estadística & datos numéricos , Promoción de la Salud/estadística & datos numéricos , Salud Pública/estadística & datos numéricos , Animales , América Central , Niño , Servicios de Salud del Niño/economía , Servicios de Salud del Niño/organización & administración , Servicios de Salud del Niño/estadística & datos numéricos , Costos y Análisis de Costo , Dengue/prevención & control , Países en Desarrollo , Femenino , Promoción de la Salud/economía , Promoción de la Salud/organización & administración , Humanos , Programas de Inmunización/economía , Programas de Inmunización/organización & administración , Programas de Inmunización/estadística & datos numéricos , Cooperación Internacional , Malaria/prevención & control , Desnutrición/prevención & control , Servicios de Salud Materna/economía , Servicios de Salud Materna/organización & administración , Servicios de Salud Materna/estadística & datos numéricos , México , Control de Mosquitos/economía , Control de Mosquitos/organización & administración , Control de Mosquitos/estadística & datos numéricos , Embarazo , Servicios Preventivos de Salud/economía , Servicios Preventivos de Salud/organización & administración , Servicios Preventivos de Salud/estadística & datos numéricos , Servicios de Salud Reproductiva/economía , Servicios de Salud Reproductiva/organización & administración , Servicios de Salud Reproductiva/estadística & datos numéricosRESUMEN
Since the Salud Mesoamerica 2015 initiative (SM-2015) aim is to improve health and nutrition conditions of those most vulnerable in Mesoamerica, the goal of the evaluation is to generate evidence of the joint effectiveness of a package of interventions designed to improve the health conditions. We propose a mix design for the evaluation, which will allow to know the magnitude of changes attributable to the interventions, as well as the meanings of these changes for the target population, taking into account the specificities of each country. The main axis of this design is a locality panel where information about individuals, households, and health facilities (first and second level) will also be collected. The evaluation design described in this paper was developed between June and December, 2009, and it was integrated during workshops in Cuernavaca (Mexico), Managua (Nicaragua), and San Jose (Costa Rica). The proposed design will allow to generate evidence about the joint effectiveness of the package of interventions proposed for the SM-2015. The success of this design rests on the political commitment of countries and donors.
Asunto(s)
Promoción de la Salud/organización & administración , Investigación sobre Servicios de Salud/métodos , Salud Pública , Animales , América Central , Niño , Servicios de Salud del Niño/economía , Servicios de Salud del Niño/organización & administración , Servicios de Salud del Niño/estadística & datos numéricos , Análisis Costo-Beneficio , Dengue/prevención & control , Países en Desarrollo , Femenino , Objetivos , Promoción de la Salud/economía , Humanos , Programas de Inmunización/economía , Programas de Inmunización/organización & administración , Programas de Inmunización/estadística & datos numéricos , Recién Nacido , Cooperación Internacional , Malaria/prevención & control , Desnutrición/prevención & control , Servicios de Salud Materna/economía , Servicios de Salud Materna/organización & administración , Servicios de Salud Materna/estadística & datos numéricos , México , Control de Mosquitos/economía , Control de Mosquitos/organización & administración , Control de Mosquitos/estadística & datos numéricos , Embarazo , Servicios Preventivos de Salud/economía , Servicios Preventivos de Salud/organización & administración , Servicios Preventivos de Salud/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud/métodos , Servicios de Salud Reproductiva/economía , Servicios de Salud Reproductiva/organización & administración , Servicios de Salud Reproductiva/estadística & datos numéricos , Proyectos de InvestigaciónRESUMEN
OBJETIVO: Presentar y analizar información de costo-efectividad de intervenciones propuestas por la Iniciativa Mesoamericana de Salud (IMS) en las áreas de nutrición infantil, inmunizaciones, paludismo, dengue y salud materno-infantil y reproductiva. MATERIAL Y MÉTODOS: Se llevó a cabo una revisión sistemática de la literatura de evaluaciones económicas publicadas entre el año 2000 y agosto 2009 sobre intervenciones en las áreas de la salud mencionadas, en los idiomas inglés y español. RESULTADOS: Las intervenciones en nutrición y de salud materno-infantil mostraron ser altamente costo-efectivas (con rangos menores a US$200 por año de vida ajustado por discapacidad [AVAD] evitado para nutrición y US$100 para materno-infantil). En dengue sólo se encontró información sobre la aplicación de larvicidas, cuya razón de costo efectividad estimada fue de US$40.79 a US$345.06 por AVAD evitado. Respecto al paludismo, las intervenciones estudiadas resultaron costo-efectivas (
OBJECTIVE: Present and analyze cost-effectiveness information of public health interventions proposed by the Mesoamerican Health Initiative in child nutrition, vaccination, malaria, dengue, and maternal, neonatal, and reproductive health. MATERIAL AND METHODS: A systematic literature review was conducted on cost-effectiveness studies published between January 2000 and August 2009 on interventions related to the health areas previously mentioned. Studies were included if they measured effectiveness in terms of Disability-Adjusted Life Year (DALY) or death averted. RESULTS: Child nutrition and maternal and neonatal health interventions were found to be highly cost-effective (most of them below US$200 per DALY averted for nutritional interventions and US$100 for maternal and neonatal health). For dengue, information on cost-effectiveness was found just for application of larvicides, which resulted in a cost per DALY averted ranking from US$40.79 to US$345.06. Malarial interventions were found to be cost-effective (below US$150 per DALY averted or US$4,000 per death averted within Africa). In the case of pneumococcus and rotavirus vaccination, cost-effectiveness estimates were always above one GDP per capita per DALY averted. CONCLUSIONS: In Mesoamerica there are still important challenges in child nutrition, vaccination, malaria, dengue and maternal, neonatal, and reproductive health, challenges that could be addressed by scaling-up technically feasible and cost-effective interventions.
Asunto(s)
Animales , Niño , Femenino , Humanos , Embarazo , Bibliometría , Análisis Costo-Beneficio/estadística & datos numéricos , Promoción de la Salud/estadística & datos numéricos , Salud Pública/estadística & datos numéricos , América Central , Servicios de Salud del Niño/economía , Servicios de Salud del Niño/organización & administración , Servicios de Salud del Niño/estadística & datos numéricos , Costos y Análisis de Costo , Dengue/prevención & control , Países en Desarrollo , Promoción de la Salud/economía , Promoción de la Salud/organización & administración , Programas de Inmunización/economía , Programas de Inmunización/organización & administración , Programas de Inmunización/estadística & datos numéricos , Cooperación Internacional , Malaria/prevención & control , Desnutrición/prevención & control , Servicios de Salud Materna/economía , Servicios de Salud Materna/organización & administración , Servicios de Salud Materna/estadística & datos numéricos , México , Control de Mosquitos/economía , Control de Mosquitos/organización & administración , Control de Mosquitos/estadística & datos numéricos , Servicios Preventivos de Salud/economía , Servicios Preventivos de Salud/organización & administración , Servicios Preventivos de Salud/estadística & datos numéricos , Servicios de Salud Reproductiva/economía , Servicios de Salud Reproductiva/organización & administración , Servicios de Salud Reproductiva/estadística & datos numéricosRESUMEN
El propósito de la iniciativa Salud Mesoamérica 2015 (SM-2015) es mejorar el estado de salud y nutrición de la población con mayor grado de vulnerabilidad en Mesoamérica. El objetivo de la evaluación es generar evidencia sobre la efectividad conjunta de un paquete de intervenciones diseñadas para mejorar las condiciones de salud en la región. Se propone una evaluación de impacto con métodos mixtos, para conocer la magnitud de los cambios atribuibles a la SM-2015, e identificar los significados de estos cambios para la población objetivo, en el contexto de cada país. El eje conductor es un panel de localidades con el que se colectará información de individuos, hogares y unidades de salud de primero y segundo nivel de atención. El diseño que se describe en este documento fue desarrollado entre junio y diciembre de 2009, y su articulación se llevó a cabo en talleres realizados en Cuernavaca (México), Managua (Nicaragua), y San José (Costa Rica). El diseño propuesto permitirá generar evidencia sobre la efectividad conjunta del paquete de intervenciones propuesto en los planes maestros mesoamericanos. El éxito de este diseño radica en la voluntad y en el compromiso político de los países y los donantes.
Since the Salud Mesoamerica 2015 initiative (SM-2015) aim is to improve health and nutrition conditions of those most vulnerable in Mesoamerica, the goal of the evaluation is to generate evidence of the joint effectiveness of a package of interventions designed to improve the health conditions. We propose a mix design for the evaluation, which will allow to know the magnitude of changes attributable to the interventions, as well as the meanings of these changes for the target population, taking into account the specificities of each country. The main axis of this design is a locality panel where information about individuals, households, and health facilities (first and second level) will also be collected. The evaluation design described in this paper was developed between June and December, 2009, and it was integrated during workshops in Cuernavaca (Mexico), Managua (Nicaragua), and San Jose (Costa Rica). The proposed design will allow to generate evidence about the joint effectiveness of the package of interventions proposed for the SM-2015. The success of this design rests on the political commitment of countries and donors.
Asunto(s)
Animales , Niño , Femenino , Humanos , Recién Nacido , Embarazo , Promoción de la Salud/organización & administración , Investigación sobre Servicios de Salud/métodos , Salud Pública , América Central , Servicios de Salud del Niño/economía , Servicios de Salud del Niño/organización & administración , Servicios de Salud del Niño/estadística & datos numéricos , Análisis Costo-Beneficio , Dengue/prevención & control , Países en Desarrollo , Objetivos , Promoción de la Salud/economía , Programas de Inmunización/economía , Programas de Inmunización/organización & administración , Programas de Inmunización/estadística & datos numéricos , Cooperación Internacional , Malaria/prevención & control , Desnutrición/prevención & control , Servicios de Salud Materna/economía , Servicios de Salud Materna/organización & administración , Servicios de Salud Materna/estadística & datos numéricos , México , Control de Mosquitos/economía , Control de Mosquitos/organización & administración , Control de Mosquitos/estadística & datos numéricos , Servicios Preventivos de Salud/economía , Servicios Preventivos de Salud/organización & administración , Servicios Preventivos de Salud/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud/métodos , Servicios de Salud Reproductiva/economía , Servicios de Salud Reproductiva/organización & administración , Servicios de Salud Reproductiva/estadística & datos numéricos , Proyectos de InvestigaciónRESUMEN
OBJECTIVE: To assess criterion validity of a survey that uses contingent valuation to elicit estimates of client willingness-to-pay (WTP) higher prices for family planning and reproductive health services in three developing countries. METHODS: Criterion validity was assessed at the individual client level and at the aggregate service level. Individual-level validity was assessed using a longitudinal approach in which we compared what women said they would do with their actual utilization behavior following a price increase. Aggregate-level validity was assessed using predictions derived from cross-sectional surveys and comparing these with actual utilization data. Phi coefficients and correlation statistics were calculated for individual and aggregate-level analyses, respectively. RESULTS: None of the three individual-level cohorts exhibited statistically significant relationships between predicted and actual WTP. Approximately 70% of clients returned for follow-up care after the price increase, regardless of their responses on the WTP survey. For the aggregate analysis the correlation coefficient between predicted and actual percentage change in demand was not significant. Many clinics experienced higher demand after prices increased, suggestive of shifting demand curves. CONCLUSIONS: A validated technique for predicting utilization subsequent to a price increase would be highly useful for program managers. Our individual and aggregate-level results cast doubt on the usefulness of WTP surveys for this purpose.
Asunto(s)
Honorarios y Precios/tendencias , Encuestas de Atención de la Salud/métodos , Aceptación de la Atención de Salud/psicología , Servicios de Salud Reproductiva/economía , Servicios de Salud Reproductiva/estadística & datos numéricos , Mujeres/psicología , Adulto , Sesgo , Estudios Transversales , Países en Desarrollo , Egipto , El Salvador , Femenino , Predicción , Encuestas de Atención de la Salud/normas , Honduras , Humanos , Estudios Longitudinales , Aceptación de la Atención de Salud/estadística & datos numéricos , Valor Predictivo de las Pruebas , Servicios de Salud Reproductiva/tendencias , Encuestas y Cuestionarios/normas , Mujeres/educaciónRESUMEN
INTRODUCTION: High birth and immigration rates in the US-Mexico border region have led to large population increases in recent decades. Two national, 10 state, and more than 100 local government entities deliver reproductive health services to the region's 14 million residents. Limited standardized information about health risks in this population hampers capacity to address local needs and assess effectiveness of public health programs. METHODS: We worked with binational partners to develop a system for reproductive health surveillance in the sister communities of Matamoros, Tamaulipas, Mexico, and Cameron County, Texas, as a model for a broader regional approach. We used a stratified, systematic cluster-sampling design to sample women giving birth in hospitals in each community during an 81-day period (August 21-November 9) in 2005. We conducted in-hospital computer-assisted personal interviews that addressed prenatal, behavioral, and lifestyle factors. We evaluated survey response rates, data quality, and other attributes of effective surveillance systems. We estimated population coverage using vital records data. RESULTS: Among the 999 women sampled, 947 (95%) completed interviews, and the item nonresponse rate was low. The study sample included 92.7% of live births in Matamoros and 98.3% in Cameron County. Differences between percentage distributions of birth certificate characteristics in the study and target populations did not exceed 2.0. Study population coverage among hospitals ranged from 92.9% to 100.0%, averaging 97.3% in Matamoros and 97.4% in Cameron County. CONCLUSION: Results indicate that hospital-based sampling and postpartum interviewing constitute an effective approach to reproductive health surveillance. Such a system can yield valuable information for public health programs serving the growing US-Mexico border population.
Asunto(s)
Cooperación Internacional , Servicios de Salud Reproductiva/organización & administración , Servicios de Salud para Mujeres/organización & administración , Recolección de Datos/economía , Femenino , Hispánicos o Latinos , Administración Hospitalaria , Humanos , México , Proyectos Piloto , Vigilancia de la Población , Servicios de Salud Reproductiva/economía , Texas , Servicios de Salud para Mujeres/economíaRESUMEN
OBJETIVOS: Estimar el gasto en salud reproductiva en México durante el año 2003, analizar su distribución según los principales programas, agentes de financiamiento y proveedores de bienes y servicios de salud, y evaluar la relación entre el gasto en salud reproductiva y algunos indicadores económicos de los estados, mediante la metodología de cuentas en salud. MÉTODOS: Se estimó el gasto en salud reproductiva entre enero y diciembre de 2003, tanto a nivel nacional como estatal. Se utilizó la metodología de cuentas en salud ajustada a las particularidades de México a partir de información pública y privada. El gasto se calculó para los cuatro principales programas de salud reproductiva (salud materno-perinatal, planificación familiar, cáncer cervicouterino y cáncer de mama) según los diferentes agentes de financiamiento, proveedores de bienes y servicios y funciones de salud, tanto para el sector público como privado. Se estimó el gasto público estatal por beneficiaria y se analizó su relación con el gasto público en salud y el producto interno bruto (PIB) anual per cápita de cada estado. RESULTADOS: El gasto en salud reproductiva en México durante el año 2003 fue de 2 912,6 millones de dólares estadounidenses y representó 0,5 por ciento del PIB nacional en 2003 y poco más de 8 por ciento del gasto en salud. El gasto fue mayor en los agentes públicos (53,5 por ciento) que en los privados (46,5 por ciento). El programa de salud materno-perinatal presentó el mayor gasto, principalmente por partos y complicaciones; casi 50 por ciento de ese total provino de pagos directos de los hogares. El gasto en planificación familiar fue mayormente público y representó 5,9 por ciento del gasto total. Del gasto en salud reproductiva, 7,9 por ciento correspondió a los programas de cáncer cervicouterino y de mama. El gasto público promedio en salud reproductiva por beneficiaria fue de 680,03 USD y su distribución estatal estuvo asociada con el gasto público...
OBJECTIVES: To estimate reproductive health expenditures in Mexico during 2003; analyze how costs were distributed across the main programs, funding entities, and providers of health goods and services; and evaluate the relationship between reproductive health expenditures and economic indicators in different states, using health accounts methods. METHODS: We estimated reproductive health expenditures between January and December 2003, at the national and state level. We used health accounts methods adjusted for the particular characteristics of Mexico on the basis of information from public and private sources. Expenditures were calculated for the four main reproductive health programs (maternal-perinatal health, family planning, cervical and uterine cancer, and breast cancer) according to different funding entities, goods and services providers, and functions of health care, in both the public and private sector. We estimated public expenditures by state per beneficiary, and analyzed how these costs were related with pubic health care expenditures and annual per capita gross domestic product (GDP) for each state. RESULTS: The reproductive health expenditures in Mexico during the year 2003 were US$ 2.912 6 billion, a figure that represented 0.5 percent of the national GDP in 2003 and slightly more than 8 percent of the total health care expenditures. Costs were higher for public entities (53.5 percent) than for private entities (46.5 percent). The maternal-perinatal health program accounted for the highest costs, mainly from deliveries and complications; direct payments from households accounted for nearly 50 percent of the total figure. Costs for family planning were accrued mainly in the public sector, and represented 5.9 percent of the total expenditure. Of the total spending on reproductive health, 7.9 percent was devoted to cervical and uterine cancer and breast cancer programs. Mean public expenditures on reproductive health per...
Asunto(s)
Humanos , Gastos en Salud , Servicios de Salud Reproductiva/economía , México , Sector Privado , Sector PúblicoRESUMEN
OBJECTIVE: To determine whether female adolescents from low-income areas in Managua were satisfied with the sexual and reproductive health (SRH) care provided through a competitive voucher programme and to analyse the determinants of their satisfaction. DESIGN: A community-based quasi-experimental intervention study from 2000 to 2002. SETTING: Low-income areas of Managua. INTERVENTION: Distribution of 28,711 vouchers giving adolescents free-access to SRH care in 19 clinics; training and support for health care providers. STUDY PARTICIPANTS: A random sample of 3009 girls from 12 to 20 years completed self-administered questionnaires: 700 respondents had used this care in the last 15 months, 221 with voucher (users-with-voucher) and 479 without voucher (users-without-voucher). MAIN OUTCOME MEASURES: User satisfaction; Satisfaction with clinic reception; Clarity of doctors' explanations. RESULTS: User satisfaction was significantly higher in users-with-voucher compared with users-without-voucher [Adjusted odds-ratio (AOR) = 2.2; 95% confidence interval (95% CI) = 1.2-4.0]. Voucher use was associated with more frequent satisfaction with clinic reception, especially among sexually active girls not yet pregnant or mother (AOR = 6.9; 95% CI = 1.5-31.8). The clarity of doctors' explanations was not perceived differently (AOR = 1.4; 95% CI = 0.9-2.2). User satisfaction was highly correlated to satisfaction with clinic reception and clarity of doctors' explanations (P < 0.001). Longer consultation times, shorter waiting times, older age, and having a female doctor positively influenced user satisfaction. CONCLUSION: Voucher use by teenage girls was associated with a better perceived SRH care. This is an important result, given the crucial role user satisfaction plays in adoption and continued use of health care and contraceptives. Though more research is needed, confidential and guaranteed access appear key factors to voucher success.
Asunto(s)
Servicios de Salud del Adolescente/normas , Satisfacción del Paciente/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Servicios de Salud Reproductiva/normas , Adolescente , Servicios de Salud del Adolescente/economía , Anticoncepción , Escolaridad , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Comercialización de los Servicios de Salud , Nicaragua , Pobreza , Evaluación de Programas y Proyectos de Salud , Servicios de Salud Reproductiva/economía , Encuestas y Cuestionarios , Atención no Remunerada/economíaRESUMEN
OBJECTIVES: To estimate reproductive health expenditures in Mexico during 2003; analyze how costs were distributed across the main programs, funding entities, and providers of health goods and services; and evaluate the relationship between reproductive health expenditures and economic indicators in different states, using health accounts methods. METHODS: We estimated reproductive health expenditures between January and December 2003, at the national and state level. We used health accounts methods adjusted for the particular characteristics of Mexico on the basis of information from public and private sources. Expenditures were calculated for the four main reproductive health programs (maternal-perinatal health, family planning, cervical and uterine cancer, and breast cancer) according to different funding entities, goods and services providers, and functions of health care, in both the public and private sector. We estimated public expenditures by state per beneficiary, and analyzed how these costs were related with pubic health care expenditures and annual per capita gross domestic product (GDP) for each state. RESULTS: The reproductive health expenditures in Mexico during the year 2003 were US$ 2.912 6 billion, a figure that represented 0.5% of the national GDP in 2003 and slightly more than 8% of the total health care expenditures. Costs were higher for public entities (53.5%) than for private entities (46.5%). The maternal-perinatal health program accounted for the highest costs, mainly from deliveries and complications; direct payments from households accounted for nearly 50% of the total figure. Costs for family planning were accrued mainly in the public sector, and represented 5.9% of the total expenditure. Of the total spending on reproductive health, 7.9% was devoted to cervical and uterine cancer and breast cancer programs. Mean public expenditures on reproductive health per beneficiary were US$ 680.03, and differences between states were associated with differences in public health expenditures (r=0.80; P<0.001) and per capita GDP (r=0.75; P<0.0001). CONCLUSIONS: The health accounts method allowed us to estimate reproductive health expenditures in Mexico in 2003. Enhancing reproductive health actions and programs by basing expenditure assignments on evidence and focusing on least-favored populations is an ethical, human rights, and developmental imperative.