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Inequalities in health care utilization in Mexico.

Author(s) Christine Göppel1, Linus Grabenhenrich2, Peter Tinnemann3.
Affiliation(s) 1Institute of Social Medicine, Epidemiology and Health Economics, Charité Berlin, Berlin, Germany, 2Institute of Social Medicine, Epidemiology and Health Economics, Charité Berlin, Berlin, Germany, 3Institute of Social Medicine, Epidemiology and Health Economics, Charité Berlin, Berlin, Germany.
Country - ies of focus Mexico
Relevant to the conference tracks Social Determinants and Human Rights
Summary Mexico´s way towards Universal Health Coverage: Are the Mexican poor still at a disadvantage in health care utilization?
Background The cornerstone of the Mexican health reform towards Universal Health Coverage is the 2003 introduction of a voluntary Popular Health Insurance (Seguro Popular). It aims to ensure access to health care services for vulnerable population groups and to address inequities in health care utilization for those facing financial hardship through sickness.
Objectives To quantify the Mexican health reforms success we identified the characteristics of population subgroups that contribute attributably to disparities in health care utilization of older adults and evaluated socio-economic inequities considering the distribution of needs for health services across the income groups.
Methodology Data of the WHO “Study on global AGEing and adult health” (SAGE) Wave1, conducted 2009/10 in Mexico, was examined for determinants of health care utilization. The concentration curve and index of health care utilization were used to measure socioeconomic inequalities in health care utilization and standardized for health needs to assess inequities in health care utilization.
Results Among the SAGE Wave1 participants from Mexico, less than half of the population saw a doctor in the 12 months prior to the survey. Income is by far the strongest determinant of an older person´s probability of using health care services. Other associated factors are chronic conditions, rural residence and education of the household head respectively. Achieved access of health care services is concentrated on the richer quintiles of the population. Poor population subgroups use outpatient services less frequently, despite presenting worse health conditions. Pro-rich-inequalities in health care service utilization appear as a matter of inequity and reflect, at least partly,  inequitable distribution of health care services utilization.
Conclusion The study measures specific indicators of the Mexican health system performance as it moves towards Universal Health Coverage. Ongoing socio-economic inequalities in health care utilization are confirmed. No evidence is found that insurance coverage increases health care utilization among the elderly poor. Mexican health policy makers should address prevailing financial obstacles and improve policies to further promote equitable and sustainable access to health services.

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