PDF(Pubmed)
Abstract：
OBJECTIVE: The Mexican government has pursued multiple initiatives to improve healthcare coverage and financial protection. Yet, out-of-pocket health spending and use of private sector providers in Mexico remains high. In this paper, we sought to describe the characteristics of public and private healthcare users, describe recent visit quality across provider types, and to assess whether perceiving the public healthcare sector as poor quality is associated with private health sector use.
RESULTS: We analyzed the cross-sectional People\'s Voice Survey conducted from December 2022 to January 2023. We used Chi-square tests to compare contextual, individual, and need-for-care factors and ratings of most recent visits between users of public (social security and other public providers) and private sector providers (stand-alone private providers and providers adjacent to pharmacies). We used a multivariable Poisson regression model to assess associations between low ratings of public healthcare sources and the use of private care. Among the 811 respondents with a healthcare visit in the past year, 31.2% used private sources. Private healthcare users were more educated and had higher incomes than public healthcare users. Quality of most recent visit was rated more highly in private providers (70.2% rating the visit as excellent or very good for stand-alone private providers and 54.3% for pharmacy-adjacent doctors) compared to social security (41.6%) and other public providers (46.6%). Those who perceived public health institutions as low quality had a higher probability of seeking private healthcare.
CONCLUSIONS: Users rated public care visits poorly relative to private care; at the population level, perceptions of poor quality care may drive private care use and hence out-of-pocket costs. Improving public healthcare quality is necessary to ensure universal health coverage.
RESULTS: We analyzed the cross-sectional People\'s Voice Survey conducted from December 2022 to January 2023. We used Chi-square tests to compare contextual, individual, and need-for-care factors and ratings of most recent visits between users of public (social security and other public providers) and private sector providers (stand-alone private providers and providers adjacent to pharmacies). We used a multivariable Poisson regression model to assess associations between low ratings of public healthcare sources and the use of private care. Among the 811 respondents with a healthcare visit in the past year, 31.2% used private sources. Private healthcare users were more educated and had higher incomes than public healthcare users. Quality of most recent visit was rated more highly in private providers (70.2% rating the visit as excellent or very good for stand-alone private providers and 54.3% for pharmacy-adjacent doctors) compared to social security (41.6%) and other public providers (46.6%). Those who perceived public health institutions as low quality had a higher probability of seeking private healthcare.
CONCLUSIONS: Users rated public care visits poorly relative to private care; at the population level, perceptions of poor quality care may drive private care use and hence out-of-pocket costs. Improving public healthcare quality is necessary to ensure universal health coverage.
摘要：
目标：墨西哥政府采取了多项举措来改善医疗保健覆盖率和财务保护。然而，墨西哥的自付医疗支出和私营部门提供者的使用仍然很高。在本文中,我们试图描述公共和私人医疗保健用户的特征，描述跨提供商类型的最近访问质量，并评估认为公共医疗部门质量差是否与私人医疗部门的使用有关。
结果：我们分析了2022年12月至2023年1月进行的横截面人民声音调查。我们使用卡方检验来比较上下文，个人,以及公共（社会保障和其他公共提供者）和私营部门提供者（独立的私人提供者和与药房相邻的提供者）的用户之间的最近一次访问的护理需求因素和评级。我们使用多变量Poisson回归模型来评估公共医疗来源的低评级与私人护理的使用之间的关联。在过去一年接受医疗保健访问的811名受访者中，31.2%使用私人来源。与公共医疗保健用户相比，私人医疗保健用户受教育程度更高，收入更高。与社会保障（41.6％）和其他公共提供者（46.6％）相比，私人提供者对最近一次访问的质量给予了更高的评价（对于独立的私人提供者，70.2％的评价为优秀或非常好，对于与药房相邻的医生，54.3％）。那些认为公共卫生机构质量低的人寻求私人医疗保健的可能性更高。
结论：相对于私人护理，用户对公共护理访问的评价较差；在人口水平上，对低质量护理的看法可能会推动私人护理的使用，从而导致自付费用。提高公共医疗质量是确保全民健康覆盖的必要条件。
结果：我们分析了2022年12月至2023年1月进行的横截面人民声音调查。我们使用卡方检验来比较上下文，个人,以及公共（社会保障和其他公共提供者）和私营部门提供者（独立的私人提供者和与药房相邻的提供者）的用户之间的最近一次访问的护理需求因素和评级。我们使用多变量Poisson回归模型来评估公共医疗来源的低评级与私人护理的使用之间的关联。在过去一年接受医疗保健访问的811名受访者中，31.2%使用私人来源。与公共医疗保健用户相比，私人医疗保健用户受教育程度更高，收入更高。与社会保障（41.6％）和其他公共提供者（46.6％）相比，私人提供者对最近一次访问的质量给予了更高的评价（对于独立的私人提供者，70.2％的评价为优秀或非常好，对于与药房相邻的医生，54.3％）。那些认为公共卫生机构质量低的人寻求私人医疗保健的可能性更高。
结论：相对于私人护理，用户对公共护理访问的评价较差；在人口水平上，对低质量护理的看法可能会推动私人护理的使用，从而导致自付费用。提高公共医疗质量是确保全民健康覆盖的必要条件。
