Cobertura geográfica del sistema mexicano de salud y análisis espacial de la utilización de hospitales generales de la Secretaría de Salud en 1998 / Geographical coverage of the Mexican Healthcare System and a spatial analysis of utilization of its General Hospitals in 1998

Objetivo. Determinar la cobertura geográfica del Sistema Mexicano de Salud y analizar la utilización en 1998 de los hospitales de la Secretaría de Salud (SSA). Material y métodos. Se desarrolló un Sistema de Información Geográfica (SIG) con información sociodemográfica por localidad y ubicación espacial de unidades de atención de todo el sector salud, así como el registro de egresos por hospital de la SSA. Se determinó la utilización en 217 hospitales generales de la SSA mediante un modelo de estimación de máxima verosimilitud, que incluyó información sobre los recursos humanos, la infraestructura adicional y la población 25 km a la redonda. Resultados. En 1998, 10 806 localidades con 72 millones de habitantes contaban con al menos una unidad de atención de salud del sector público y 97.2 por ciento de la población se encontraba a menos de 50 km de una, pero más de 18 millones de personas vivían en localidades rurales sin unidades de atención. El promedio de ocupación fue de 48.5±28.5 por cada 100 camas/año, con gran variabilidad intra e interestatal. La utilización se asoció significativamente con el número de los médicos en la unidad, y en unidades del Instituto Mexicano del Seguro Social con la infraestructura adicional e índice de marginación. Conclusiones. La utilización del SIG eleva la capacidad analítica y proporciona estimadores más realistas de la cobertura y utilización de hospitales del sector

[Geographical coverage of the Mexican Healthcare System and a spatial analysis of utilization of its General Hospitals in 1998]. / Cobertura geográfica del sistema mexicano de salud y análisis espacial de la utilización de hospitales generales de la Secretaría de Salud en 1998.

OBJECTIVE: To describe the geographical coverage of the Mexican Healthcare System (MHS) services and to assess the utilization of its General Hospitals. MATERIAL AND METHODS: A Geographic Information System (GIS) was used to include sociodemographic data by locality, the geographical location of all MHS healthcare services, and data on hospital discharge records. A maximum likelihood estimation model was developed to assess the utilization levels of 217 MHS General Hospitals. The model included data on human resources, additional infrastructure, and the population within a 25 km radius. RESULTS: In 1998, 10,806 localities with 72 million inhabitants had at least one public healthcare unit, and 97.2% of the population lived within 50 km of a healthcare unit; however, over 18 million people lived in rural localities without a healthcare unit. The mean annual hospital occupation rate was 48.5 +/- 28.5 per 100 bed/years, with high variability within and between states. Hospital occupation was significantly associated with the number of physicians in the unit, and in the Mexican Institute of Social Security units utilization was associated with additional health infrastructure, and with the population's poverty index. CONCLUSIONS: GIS analysis allows improved estimation of the coverage and utilization of MHS hospitals.

Percursos e percalços do trabalho do psicólogo em hospital geral / Courses and perquisites of psychologist work in general hospital

Este trabalho fala da experiência de reestruturaçäo do Serviço de Psicologia Cínica do Grupo Hospitalar Conceiçäo, buscando delimitar prioridades para suas atividades através da Análise Institucional. Propöe-se, tambem, a pensar, em relaçäo ao ambiente hospitalar, o lugar do psicólogo, marcado pela tarefa de lidar com as angústias provocadas pela dor e a morte. Em última instância, visa ao aprimoramento do trabalho em saúde pública através do modelo assistencial apresentado, desde o questionamento do papael do psicólogo

[Second-level hospitals in the health care model for the population without coverage]. / Los hospitales de segundo nivel en el modelo de atención para la salud de la población abierta.

Hospital health care may be a complement of ambulatory care and promotes the integration of a real National Health System. The measures adopted in the last years in Mexico to create a net of second level hospitals under a new model of health care are described; decentralization, the creation of high quality regional health care centers, administrative modernization, new financial formulas and community participation are some of the analyzed topics.

A social systems model of hospital utilization.

A social systems model for the health services system serving the state of New Mexico is presented. Utilization of short-term general hospitals is viewed as a function of sociodemographic characteristics of the population and of the supply of health manpower and facilities available to that population. The model includes a network specifying the causal relationships hypothesized as existing among a set of social, demographic, and economic variables known to be related to the supply of health manpower and facilities and to their utilization. Inclusion of feedback into the model as well as lagged values of physician supply variables permits examination of the dynamic behavior of the social system over time. A method for deriving the reduced form of the structural model is presented along with the reduced-form equations. These equations provide valuable information for policy decisions regarding the likely consequences of changes in the structure of the population and in the supply of health manpower and facilities. The structural and reduced-form equations have been used to predict the consequences for one New Mexico county of state and federal policies that would affect the organization and delivery of health services.