Mexico is currently confronting numerous challenges in its efforts to deliver high-quality healthcare services to its inhabitants, resulting in prolonged illness. As a result, the Mexican population is constantly confronted with starvation, infectious diseases, and reproductive health difficulties. Other health issues include an increase in the frequency of communicable diseases, as well as rates of violence and injury. As a result, the spread of the health concerns stated above is seen among different categories of people and geographical areas, resulting in inequalities in health outcomes in the country. Additionally, Mexico's health-care system has been overburdened, resulting in poor quality medical services for its inhabitants (Frenk, 2007). A survey carried out in 2000 showed that approximately 76% of the Mexican population advocated for changes in their health system (Torres, Ramírez, Hernández & Franco, 2003). The system of healthcare in Mexico is not capable of keeping up with the financial pressures that are caused by the illnesses affecting its citizens. In attempts of controlling and managing the ever-increasing health problems that are complicated, the government of Mexico has developed a health reform initiative which addressed the inequities in accessing medical services. The problem of unequal access to health care was solved through the implementation of the Seguro Popular Health Insurance, a program which covered for over 12 million families. Additionally, the Seguro Popular assists in the provision of beneficiaries' facilities and healthcare services, in coordination with the Instituto Mexicano de Seguridad Social (IMSS). On the same note, the government of Mexico started the Crusade for Health Care Quality which provided high-quality services to Mexicans. To this end, this paper aims at assessing public health in Mexico by determining the manner in which The execution of these healthcare systems has targeted different segments of the population.
Data Collection Process
Source of Data
This paper gathered data from analyzing the survey of ENSANut of 2006 which involved questionnaires and interviews of persons in 48,304 homes and 206,700 people. This was a study bankrolled by the federal government of Mexico through the cooperation of the National Institute of Public Health (Merikangas, Sampson & Ladea, 2011). During the survey, there was the use of sampling in over 32 Mexican states, which was relevant to the geographical size of Mexico. There was the random selection of a user of healthcare services and an adult in every home where the survey was carried out.
Population of Study
This study made use of a population subsample which utilized any health services because of injury, sickness, accident, rehabilitation or prevention in six months before the survey was carried out. However, this did not include children of 17 years and below, and the respondents cooperated well by providing answers that were relevant for our study.
Variables of the Study
Independent Variables
In our study, there was the grouping of the sample depending on the demographic characteristics such as gender, age, indigenous status, the status of marriage, level of education, health insurance coverage and the income levels as shown in Table 1. The primary independent variable used was the subsystem of health through which beneficiaries received medical care services, and the respondents were categorized into five. The five groups were SSA, IMSS, Private, ISSSTE, and Other, where others represent less used organizations employed in the delivery of healthcare services.
Dependent Variables
As a measure of accessing the quality of healthcare services, there was an examination of the self-revealed conditions. These conditions included, firstly, whether or not the interviewee would consider the health care services as good or excellent. Secondly, whether or not our study population would seek medical care in the same health institutions again. Finally, there was a question on whether or not the interviewees would believe that there was an improvement in their health, which would lead to accessing medical care services.
Analysis of Data
The fundamental analysis included assessing the measures of the subsystem of healthcare, which involved testing for disparities using Pearson's test. After that, there were performances of logistic regression as a means of determining the connection between the three conditions and the subsystem which provides health care services.
Results
The summary of the information of the demographic characteristics alongside the leading independent and dependent variables are indicated in Table 1. The quality of healthcare was rated as excellent or good by four of every five respondents, while most of the interviewees preferred retention of the same facility to obtain medical services. In every four respondents, three concluded that there was an improvement in their health conditions because of receiving medical services. The facilities which provided medical services rendered information that almost 23.6% received medical attention from SSA, 30% from IMSS, 33.1% from private providers and 6.0% from ISSSTE. Other vendors accounted for 7.6%, while most respondents were female, the mean age was 48 years. Approximately 71% of the users of the healthcare system were in marriages and were indigenous, while 15% of the respondents reported poor or fair health status. Over half of the interviewees received the primary education while the mean monthly income was 3, 000 Mexican pesos. Many users of the health care system had insurance coverages of their health.
The percentages of respondents who provided positive answers to the quality health care measures at the varied types of institutions are shown in Table 2. There were significant differences in the quality of health services received for the three conditions. Approximately 90% of the respondents using private providers of medical care indicated that the quality of healthcare services provided was excellent or good. The lowest rated subsystems in this group were ISSSTE and IMSS with percentages of 71.9 and 69.6 respectively. There were same results when interviewees were asked whether they would return to the same health facilities to receive medical care. There were only differences in the responses to receiving healthcare services in ISSSTE and IMSS facilities for a consecutive time. There were similar answers to the replies on whether receiving health care services would lead to improvements in the conditions of healthcare as discussed in the findings in table 1. There were more positive responses from SSA and private facilities from the population of study than those of ISSSTE and IMSS.
The results from the regressions are shown in Table 3, and they show the performances of the different healthcare subsystems regarding the three conditions (Puig, Pagán, & Wong, 2009). This information is obtained after adjustments to the gender, age, marital and health status, levels of income and education of respondents. It is important to note that the three conditions of healthcare are variant regarding education, health, and age. This is shown by the fact that the young when compared to the older respondents, cannot give their ratings on the quality of health services which are provided. From our survey, respondents who were at hand to receive medical care services at ISSSTE and IMSS facilities were not very much ready to rate the quality of services compared to those who received medical care from private providers. There were better performances from SSA than those of ISSTE and IMSS, but they were lower than those provided by private sectors (Dantés, Becerril, Arreola & Frenk, 2011).
Discussion
Many Mexicans use healthcare services in the subsystems which are grouped into institutions providing services to the population without social security, social security institutions, and the private sector (Puig, Pagán, & Wong, 2009). The continual growth of the agenda on the importance of health in the many Caribbean and Latin American countries has led to an increment in the relevance of accurate measuring of the awkward dimensions and assessment of the increase in investments. The immediate rush of economic and political will has led to the improvements in the health of the population of Mexico through the advancements of policies such as Seguro Popular which is matched to the sufficient experts' responses from communities (Gómez-Dantés, 2000). This is in a bid to ensure that there is a comprehensive understanding of challenges and the appropriate allocation of resources in the most efficient way to fight these diseases. Apparently, these objectives are only achievable through the establishment of a regular evaluation and metrics foundation. To this end, the World Health Organisation has promoted the need for carrying out assessments on the healthcare systems with the aim of achieving three primary objectives (Murray & Lopez, 2013). These goals include, firstly, the enhancement of responsiveness to population expectations, improvement of the health of citizens and giving assurances to families on their financial contribution. Deductively, the improvements of health incorporate increment of the average status of health and reduction of inequalities in health (Barraza-Lloréns, M., Bertozzi, González-Pier & Gutiérrez, 2002). On the other hand, responsiveness includes respecting the dignity, autonomy and confidentiality of an individual and their families make decisions about their health. Additionally, responsiveness includes accessing social support networks during care, swift attention, provider's choice and the quality of essential amenities. Finally, financial contribution's fairness incorporates the idea that every home pays a fair share of the whole health bill expected by the country, while poor households do not pay anything entirely (Parker & Wong, 1997). Presently many researchers have paid much attention to the assessment of the performances of Mexico as relates to the objectives mentioned above.
The researchers have made reports on the achievements of the country towards the improvement of health, transition from epidemics and the improvements of financing of health for the poor households (Omran, 2005). There is also the reduction of the inequalities associated with health through the implementation of the Seguro Popular. Regardless, there is almost no attention paid to the evaluation of the responsiveness of the health care system in Mexico to its users (Barraza-Lloréns, Bertozzi, González-Pier & Gutiérrez, 2002). Therefore, this paper incorporated the comparisons of the views held by users of the Mexican healthcare system on the quality of services they are offered at every subsystem. This is regarded as one of the best research which had been applied in the data representation at the national level in showing the way quality of health is diverse or rated by their users. Our survey revealed that the users interviewed by the National Health and Nutrition Survey of 2006 regarded ISSSTE and IMSS as less favorable than other facilities (Merikangas, Sampson & Ladea, 2011). The importance of this survey is based on the idea that the users who reported on receiving health care service from these establishments were showing some levels of dissatisfaction. Contrastingly, private providers of health services were favored mostly and were rated highly by users, and the patients were very ready to return to the facilities as they had improvements in their health. Even after carrying out controls of the socioeconomic and demographic variables and the status of the population of study, the findings were still constant. Therefore, our research pointed to the fact that private institutions have a higher capability of being used and rated by patients. Accordingly, these views are important in helping us explain the reasons as to why more than half of the total Mexican health expenditure are from private sources while more than 90% are sourced from pockets of individuals.
Furthermore, our study pointed to the connection between higher education and the chances of one using private medical service providers. This was shown by the fact that over 41% of the whole population was having a degree of college or higher has made use of private services providers while 26% was having basic primary education sought these services. Therefore, this means that Mexicans who are educated receive attention from private medical providers, which explains the reason as to why education is an important aspect of predicting the perception of the quality of medical services. Nonetheless, this is unfounded when assessing different age groups because of the inconsistency of trends where people receive services depending on their age. This led us to the development of a hypothesis that age is an important factor in the prediction of the health of a population.
There are many limitations to this study, which include, firstly, only those using the services are measured and are referred herein as the measures of professed quality. This would affect excluding non-users of healthcare services in our analysis. Secondly, the standards of quality are not perfect as they only capture patients' subjective opinions who have chosen and entered into these institutions. There is no evaluation of other important factors contributing to the quality of health such as benchmarking and adhering to guidelines for treatment (Lozano, Gakidou, Feehan, & Murray, 2007). Thirdly, there was no inclusion of large survey samples of responses receiving care by the ENSANut. This implied that the category of "Others" was strictly for tertiary national health institutes, NGO'S and PEMEX hospitals. Despite the differences in these institutions from each other, respondents indicated that they use health care services in these facilities. The other limitation is that there was the use of self-report in collecting data, which gives room for biasedness and the rate of sub-optimal responses effects impacting the generalization of results from these samples. Finally, there were no conclusions drafted considering that this was a cross-sectional survey, which did not give us room for assessing changes and follow-ups in the facilities with time. Furthermore, the study's structure was ambiguous about the type of car used by interviewees, and it was unclear on whether the reflections of respondents was a reflection of their encounters. There is more work to be carried out by the institutions of Mexico towards efforts of achieving epidemiological changes and fighting diseases (Frenk, 2006). These results are an indication of the public health care inequalities which are consistent across different subsystems of health care in Mexico over the years (Puig, Pagán, & Wong, 2009).
Contributing Factors
There are many factors which when combined, influence the health of communities and individuals, and regardless of whether the study populations are unhealthy or healthy, the environment and circumstances are determinants. On this note, the health determinants in Mexico include the economic, physical and social environment and the behaviors and characteristics of an individual. Notably, the health of a person is affected by the context of their lives and, thus; blaming one for poor health status or giving credits for effective health is unnecessary. Citizens of Mexico are unlikely to have control directly over the health determinants which are capable of making people healthy or unhealthy. These factors include:
Social and income status- the greater the gap between poorest and richest individuals, the greater the difference in health
Education- people with low levels of education have higher chances of having poor health statuses because of high-stress levels and lower self-esteem
Physical environment- good health is promoted by clean air, safe water and houses, healthy workplaces and social amenities. Individuals having employment are healthier compared to those who do not have any
Social support networks – having support from families, communities and friends are attributed to better health standards. Additionally, the traditions and culture of a family or community are factors which promote health of an individual
Genetics- the role played by inheritance in the determination of the healthiness, lifespan, and chances of any particular developing sickness is undeniable. Coping skills and personal behaviors such as smoking, balanced eating and keeping active are determinants of how the health of an individual would span out
Health services – having free and easy access to medical service and using them is a measure which guarantees the prevention and treatment of diseases, which is a major influencer of health status
Gender- women, and men suffer from different disease types when they attain certain ages
Conclusion
From the above discussions, it is clear that the case study of Mexico's population health is one that serves in understanding the factors behind the functionalities of health systems. Additionally, the three subsystems have proven the drawing factor which attracts people to using a particular system, such as quality of services and the levels of income. Therefore, this study is relevant in the sense that it can be utilized as a learning tool by the Mexican government in making adjustments to its health systems. Reasonable adjustments would include ensuring that every household has health insurance coverage, improving the ease of access to health care services through the establishment of more programs. Additionally, hospitals need to be established and that there should be much-skilled personnel who guarantee quality services to clients (Parker & Wong, 1997). When these measures are implemented, there are chances of the remedy of the problems faced by the people of Mexico. As stated earlier, the population of Mexico continuously experience malnutrition, infectious diseases and challenges in reproductive health. Additional health problems include increment in the number of communicable diseases, rates of violence and injury. Seguro Popular Health Insurance is an example of a program implemented to assist in solving the problem of unequal access to health care and in providing necessary facilities. Therefore, this paper has assessed community health through the case study of Mexico.
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Appendices
Table 1
Sample of the Study
Table 2
Number of Individuals who responded positively to the quality healthcare
Table 3
Ration of Odds
Map 4
Map of Mexico
