Inequalities in coverage social groups differences in mexico
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Inequalities in Coverage: social groups differences in Mexico. Rafael Lozano MD MSc. Inequalities in Financing and Health: Measurement Frameworks and Challenges for Implementing Reforms Mexico City, 22 April 2004. Coverage Antenatal care Skilled birth attendance Cervical cancer test

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Inequalities in Coverage: social groups differences in Mexico

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Inequalities in coverage social groups differences in mexico

Inequalities in Coverage:social groups differences in Mexico

Rafael Lozano MD MSc

Inequalities in Financing and Health: Measurement

Frameworks and Challenges for Implementing Reforms

Mexico City, 22 April 2004


Measurements

Coverage

Antenatal care

Skilled birth attendance

Cervical cancer test

Inequalities

Geographical distribution

Income

Marginality

Measurements


Inequalities in coverage social groups differences in mexico

National Survey of Health System Performance (NSHSP)

  • Multistage Stratified Random Cluster Sample eachstage selection with a known probability

  • National and subnational representative

  • Sample Size 38,740 households

  • Data collection 5 months

  • Household duration 85 minutes average


Inequalities in coverage social groups differences in mexico

Antenatal Care vs Maternal Mortality

120

Tlaxcala

Yucatán

100

80

MMR per 100,000 LB

60

40

Tabasco

BC

20

0

60%

70%

80%

90%

100%

Coverage

% Coverage

64-80

81-85

85-95

Antenatal Care Coverage

Sources: ENED, 2003. INEGI/SSA 2002


Inequalities in coverage social groups differences in mexico

Neonatal mortality vs Skilled birth attendance coverage

20

18

16

Rate x 1000 LB

14

12

10

8

0.60

0.70

0.80

0.90

1.00

Coverage

Skilled Birth Attendance

% Coverage

63-90

91-95

96-98

Sources: ENED, 2003. INEGI/SSA 2002


Inequalities in coverage social groups differences in mexico

Cervical Cancer Mortality vs Detection Coverage

20.0

15.0

10.0

Rate x 100,000 women 25-64

5.0

0.0

0.50

0.53

0.56

0.59

0.62

0.65

Coverage

Cervical Cancer Detection

% Coverage

48-56

57-60

61-65

Sources: ENED, 2003. INEGI/SSA 2002


Inequalities in coverage social groups differences in mexico

Skilled Birth Attendance

1

.9

.8

Coverage

.7

.6

.5

1

2

3

4

5

6

7

8

9

10

permanent income by decile -

Cervical Cancer detection

1

.9

.8

Coverage

.7

.6

.5

1

2

3

4

5

6

7

8

9

10

permanent income by decile

Antenatal care

1

.9

.8

Coverage

.7

.6

.5

1

2

3

4

5

6

7

8

9

10

Permanent income by decile


Inequalities in coverage social groups differences in mexico

Level

Population

Municipalities

Very Low

53.6

10.1

Low

14.0

37.1

Medium

12.0

19.9

High

15.7

17.1

Very High

4.7

15.8

104*

2,442

Marginality Index, Mexico 2000

  • Census Variables

  • Illiteracy population > 15 years old

  • Incomplete elementary > 15 years old

  • Household conditions

  • 3. without electricity

  • without sewage

  • Without drinking water

  • Earth floor

  • Overcrowding

  • < 2500 population

  • Very low Income (> 2 min salary)

  • Factor Analysis

  • Transformation to Z units


Inequalities in coverage social groups differences in mexico

Low marginality

Medium marginality

Very Low marginality

1

1

1

.9

.9

.9

.8

.8

.8

.7

.7

.7

.6

.6

.6

1

2

3

4

5

1

2

3

4

5

1

2

3

4

5

permanent income by quintile

permanent income by quintile

permanent income by quintile

Very High marginality

High marginality

1

1

Antenatal Care Coverge Income by quintile and level of Marginality,

Mexico 2003

*Sources: NSHSP, 2003 CONAPO 2000.

.9

.9

.8

.8

.7

.7

.6

.6

1

2

3

4

5

1

2

3

4

5

permanent income by quintile

permanent income by quintile


Inequalities in coverage social groups differences in mexico

Very Low marginality

Low marginality

Medium marginality

1

1

1

.9

.9

.9

.8

.8

.8

.7

.7

.7

.6

.6

.6

1

2

3

4

5

1

2

3

4

5

1

2

3

4

5

income by quintile

income by quintile

income by quintile -

Very High marginality

High marginality

1

1

Skilled Birth Attendance Income by quintile and level of Marginality,

Mexico 2003

*Sources: NSHSP, 2003 CONAPO 2000.

.9

.9

.8

.8

.7

.7

.6

.6

1

2

3

4

5

1

2

3

4

5

income by quintile

income by quintile


Inequalities in coverage social groups differences in mexico

Very Low marginality

Low marginality

Medium marginality

.7

.7

.7

.6

.6

.6

.5

.5

.5

.4

.4

.4

.3

.3

.3

1

2

3

4

5

1

2

3

4

5

1

2

3

4

5

income by quintile

income by quintile

income by quintile

High marginality

Very High marginality

.7

.7

Cervical Cancer Test Income by quintile and level of Marginality, Mexico 2003

*Sources: NSHSP, 2003 CONAPO 2000.

.6

.6

.5

.5

.4

.4

.3

.3

1

2

3

4

5

1

2

3

4

5

permanent income by quintile -country-

permanent income by quintile -country-


Inequalities in coverage social groups differences in mexico

Fifth Quintile

Fourth Quintile

First Quintile

Second Quintile

1

0.9

0.8

0.7

0.6

0.5

0.4

0.3

1

Very high

high

medium

low

Ver ylow

0.9

0.8

0.7

0.6

0.5

0.4

0.3

Very high

high

medium

low

Very low

1

1

0.9

0.9

0.8

0.8

0.7

0.7

0.6

0.6

0.5

0.5

0.4

0.4

0.3

0.3

Very high

medium

low

Very low

high

Very high

high

medium

low

Very low

Cervical Cancer TestT

Antenatal Care

Skill Birth Attendance

Effective Coverage by level of marginality and Income quintile


Conclusions

High correlation between low coverage and low income but not necessarily with high marginality

Refocus the strategy of extent coverage in the reform process

Continue with the measurements of inequalities

Individual Coverage is a useful measurement for follow up the investments of reform process

Total inequality is a function of between-group and within-group inequality

Conclusions


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