Trends and challenges in diabetes for middle-income countries: Evidence from Mexico.

The epidemiological and economic burden of diabetes poses one of the main challenges for health systems worldwide. This is particularly relevant in middle-income countries because of the constant growing trends that have been observed in recent years. In order to identify trends and challenges on epidemiological and economic burden from diabetes in a middle-income country we developed a longitudinal analysis on costs and trends in the number of cases of diabetes in Mexico. The study population included total annual cases of diabetes at national level. Regarding the annual cumulative incidence for 2016 versus 2018, depending on the institution there is an increase of 9-13% (p < 0.001). Comparing the economic burden from incidence in 2016 versus 2018 (p < 0.05), there is a 26% increase. The total amount for diabetes in 2017 (US dollars) was $9,684,780,574. It includes $ 4,292,085,964 in direct costs and $ 5,392,694,610 in indirect costs. The total direct costs are: $ 510,986,406 for uninsured population; $ 1,416,132,058 for insured population; $ 2,235,969,330 for users' pockets. This is an example of what is happening in the management of diabetes care in middle-income countries and we suggest review and rethinking strategies of prevention, planning, organisation and resource allocation.

Epidemiological and financial indicators of hypertension in older adults in Mexico: challenges for health planning and management in Latin America.

This study estimated the epidemiological and financial indicators of hypertension in order to identify challenges in strategic planning and management for health systems in Latin America. This is a longitudinal study with a population base of 187 326 reported cases of older adults with hypertension, diagnosed at public health institutions in Mexico. The cost-evaluation method that was used was based on the instrumentation and consensus techniques. To estimate the epidemiological changes and financial consequences for 2015-2017, time series analyses and probabilistic models were constructed according to the Box-Jenkins technique. Regarding epidemiological changes for 2015 versus 2017, an increase of 8-12% is expected (p < 0.001). Comparing the economic impact in 2015 versus 2017 (p < 0.001), there is a 22% increase in financial requirements. The total amount estimated for hypertension in 2015 (in US dollars) was $1 575 671 330. It included $747 527 259 as direct costs and $829 144 071 as indirect costs. If the risk factors and the different healthcare services for older adults remain as they are currently, the financial consequences of epidemiological changes in older adults will have a major impact on the users' pockets, following in order of importance, on social security providers and on public assistance providers. The challenges and implications of our findings in the context of universal coverage reforms in Latin America reinforce the urgent need to develop more and better strategic planning for the prevention of chronic diseases. Copyright © 2016 John Wiley & Sons, Ltd.

Challenges of the epidemiological and economic burdens associated with hypertension in middle income countries: evidence from Mexico.

BACKGROUND: In order to identify the challenges resulting from hypertension in a middle income country, this study has developed probabilistic models to determine the epidemiological and economic burden of hypertension in Mexico. METHODS: Considering a population base of 654,701 reported cases of adults with hypertension, we conducted a longitudinal analyses in order to identify the challenges of epidemiological changes and health care costs for hypertension in the Mexican health system. The cost-evaluation method used was based on the instrumentation technique. To estimate the epidemiological changes for 2015-2017, probabilistic models were constructed according to the Box-Jenkins technique. RESULTS: Regarding changes in expected cases for 2015 vs. 2017, an increase of 12 % is expected (p < 0.001). Comparing the economic impact in 2015 versus 2017 (p < 0.001), there is a 23 % increase in financial requirements. The total amount for hypertension in 2016 (US dollars) will be $6306,685,320 Of these, $ 2990,109,035 will be as direct costs and $ 3316,576,285 as indirect costs. CONCLUSIONS: If the risk factors and care models remain as they are currently in the health system, the financial consequences will have a major impact on the out-of-pocket users, following in order of importance, on social security providers and on public assistance providers.

Subregistro de defunciones de menores y certificación de nacimiento en una muestra representativa de los 101 municipios con más bajo índice de desarrollo humano en México / Underreporting of deaths in children and birth certification in a representative sample of the 101 municipalities with lowest human development index in Mexico

OBJETIVO: Cuantificar el subregistro de la mortalidad en menores de cinco años de edad y la cobertura del certificado de nacimiento (CD) en municipios de muy bajo índice de desarrollo humano (IDH) en México. MATERIAL Y MÉTODOS: Se estudiaron todas las defunciones de menores de cinco años de edad ocurridas en 2007 y nacimientos ocurridos en 2007 y 2008 en una muestra de 20 municipios de muy bajo IDH en siete estados de México, a través de una búsqueda intencionada de defunciones y nacimientos. RESULTADOS: Se identificaron 12 muertes no incluidas en las estadísticas oficiales para un subregistro de 22.6%; 68.1% de los nacimientos no tenían CD. La falta de CD se asoció positivamente con que la madre no hablara español, que no tuviera Seguro Popular o que el nacimiento ocurriera con ayuda de partera. CONCLUSIONES: Es necesario mejorar el registro de defunciones y nacimientos en municipios de muy bajo IDH en México.

OBJECTIVE: To measure the underregistry of mortality in children under five years old, and the coverage of the Birth Certificate (BC) in municipalities with very low human development index (HDI) in Mexico. MATERIALS AND METHODS: We studied all deaths of children under five years old occurred in 2007 and all births occurred in 2007 and 2008 in a sample of 20 municipalities with very low HDI in Mexico. We conducted an intentional search of births and deaths. RESULTS: We identified 12 additional deaths not included in official registries, for an underregistration of 22.6%, and 68.1% of births did not have a BC. Lack of BC was more frequent if the mother did not speak Spanish, if she did not have Seguro Popular if the birth was attended by a traditional midwife. Conclusions. It is necessary to strengthen the registry of deaths and births in municipalities with very low HDI.

[Underreporting of deaths in children and birth certification in a representative sample of the 101 municipalities with lowest human development index in Mexico]. / Subregistro de defunciones de menores y certificación de nacimiento en una muestra representativa de los 101 municipios con más bajo índice de desarrollo humano en México.

OBJECTIVE: To measure the underregistry of mortality in children under five years old, and the coverage of the Birth Certificate (BC) in municipalities with very low human development index (HDI) in Mexico. MATERIALS AND METHODS: We studied all deaths of children under five years old occurred in 2007 and all births occurred in 2007 and 2008 in a sample of 20 municipalities with very low HDI in Mexico. We conducted an intentional search of births and deaths. RESULTS: We identified 12 additional deaths not included in official registries, for an underregistration of 22.6%, and 68.1% of births did not have a BC. Lack of BC was more frequent if the mother did not speak Spanish, if she did not have Seguro Popular if the birth was attended by a traditional midwife. Conclusions. It is necessary to strengthen the registry of deaths and births in municipalities with very low HDI.

[Problem mapping by state and federal actors for maternal health attention]. / Mapeo de problemas para la atención a la salud materna por actores estatales y federales.

OBJECTIVE: To analyze the characteristics of problems in the health system that present barriers to maternal care, according to their representation and rating by officials in different positions and social contexts. MATERIAL AND METHODS: Workshops were held with state health system officials from Mexican states with high maternal mortality (Mexico, Guerrero, Oaxaca and Veracruz) as well as with federal officials. A total of 99 health system problems were identified. Using concept mapping, 94 officials rated problems according to importance and feasibility; they were grouped into issues. Data was analyzed according to state/federal levels and the responsibilities of participants. The association was measured between responsibility profile/social context and priority issues. RESULTS: The issues of highest priority for maternal health care are infrastructure, personnel hiring and financial resources. The importance of certain issues depends on context and, to an extent, on the actors' responsibilities. CONCLUSIONS: There is consensus among actors to address the principal maternal health problems in Mexico. Important differences correspond to context. The usefulness of concept mapping to analyze problems was demonstrated.

Mapeo de problemas para la atención a la salud materna por actores estatales y federales / Problem mapping by state and federal actors for maternal health attention

OBJETIVO: Analizar las características de problemas del sistema de salud que obstaculizan la atención materna, según los representan y califican funcionarios en diversos puestos y contextos sociales. MATERIAL Y MÉTODOS: Se realizaron talleres con funcionarios de estados de alta mortalidad materna en México (México, Guerrero, Oaxaca y Veracruz) y a nivel federal. Se identificaron 99 problemas en los sistemas de salud. Utilizando mapeo conceptual, 94 funcionarios calificaron los problemas según importancia y factibilidad y se agruparon en regiones. Se analizaron los datos según estado/federación y responsabilidades de los participantes. Se midió la asociación entre perfil/contexto y la priorización de las regiones. RESULTADOS: Las regiones de alta prioridad para la atención materna son infraestructura, contratación de personal y recursos financieros. La importancia de algunas regiones depende del contexto social, aunque también en parte del perfil de responsabilidades de los actores. CONCLUSIONES: Existe consenso entre actores para enfrentar los principales problemas de salud materna en México. Diferencias importantes se deben a diversos contextos. Se demostró la utilidad del mapeo conceptual para el análisis de problemas.

OBJECTIVE: To analyze the characteristics of problems in the health system that present barriers to maternal care, according to their representation and rating by officials in different positions and social contexts. MATERIAL AND METHODS: Workshops were held with state health system officials from Mexican states with high maternal mortality (Mexico, Guerrero, Oaxaca and Veracruz) as well as with federal officials. A total of 99 health system problems were identified. Using concept mapping, 94 officials rated problems according to importance and feasibility; they were grouped into issues. Data was analyzed according to state/federal levels and the responsibilities of participants. The association was measured between responsibility profile/social context and priority issues. RESULTS: The issues of highest priority for maternal health care are infrastructure, personnel hiring and financial resources. The importance of certain issues depends on context and, to an extent, on the actors' responsibilities. CONCLUSIONS: There is consensus among actors to address the principal maternal health problems in Mexico. Important differences correspond to context. The usefulness of concept mapping to analyze problems was demonstrated.