[Mexico health care system's objectives: importance to its population and determining factors]. / Objetivos del sistema de salud en México: importancia para la población y sus determinantes.

OBJECTIVE: To document the importance to Mexico's population of the five intrinsic objectives of Mexico's present health care system (SS) and describe some of the determinants of its evaluation; the purpose is to contribute elements for defining priorities and to support the fulfillment of said objectives. MATERIAL AND METHODS: This is a cross-sectional study to the importance for Mexican population of the five objectives of SS, considered intrinsic or final in the National Evaluation and Performance Survey. The dependent variable was the ranking given by the population surveyed to each one of the objectives, based on the question: Which SS objective do you believe is most important? The independent variables (nominal and categorical) were: state of residence, type of locality, gender, age, education, present employment, quality of present state of health, last occurrence when medical assistance was needed but not received, grade of satisfaction with the operation of the country's medical care system and satisfaction with one's own health. A univaried analysis was conducted and summarized using percentages. The chi square test was used to validate or reject the hypothesis according to whether the rank assigned by the population to the SS objectives is the same, regardless of which variables were used in the comparison. A multinomial (politomic) logistical regression model was also developed to correlate the effect of the independent variables employed in the study with the importance assigned by the population to the SS objectives. The reference category of the model was the objective of improving the health of the population. The analysis was conducted using the statistical package STATA version 7.0. RESULTS: From the population studied, 31.8% reported that the most important objective is to improve treatment within the health care system. In rural areas, 31.46% of the population thinks the most important objective is to improve health, a result related with the self-perception of one's present state of health and lack of medical care. The probability of preferring the objective of improving treatment over improving health, between the populations with average education and higher levels of education is, respectively, 10% and 16% greater than the population with no education. Among the population that works independently, 31.2% consider improving health the most important objective, a greater percentage than that reported by the population of business owners and the one consisting of public and private employees. CONCLUSIONS: In general terms, the population analyzed by this study considered the improvement of treatment within the health care system to be most important, which differs from that suggested by the PRONASA 2001-2006. It was indicated that the importance assigned to the objectives can vary according to the group analyzed, its characteristics and the influence of diverse external factors on the individual, as a result of which the null hypothsesis is rejected. Variations among the populations' evaluations occurred, in particular, between the objective of improving treatment within the health care system and that of the improvement of the population's health. The obtained results guide the steps for communication and the strengthening of the health care system in order to adjust itself to the expectations of the population and support the fulfillment of the established objectives.

Objetivos del sistema de salud en México: importancia para la población y sus determinantes / Mexico health care system's objectives: importance to its population and determining factors

OBJETIVO: Documentar la importancia que tienen para la población los cinco objetivos intrínsecos del sistema de salud (SS) actual en México y describir algunas de las determinantes de su valoración; la finalidad es aportar elementos para definir prioridades y promover el cumplimiento de dichos objetivos. MATERIAL Y MÉTODOS: Este es un estudio transversal sobre la importancia para la población mexicana de los cinco objetivos del SS, considerados intrínsecos o finales en la Encuesta Nacional de Evaluación del Desempeño 2002. La variable dependiente fue la posición que la población encuestada asignó a cada uno de los objetivos del SS con base en la pregunta: "¿cuál objetivo del SS le parece el más importante?". Las variables independientes (nominales y categóricas) fueron: entidad federativa, tipo de localidad, sexo, edad, escolaridad, empleo actual, calificación del estado de salud actual, última ocasión en que necesitó asistencia médica y no la recibió, grado de satisfacción con el funcionamiento de la atención médica en el país y satisfacción con su salud. Se realizó un análisis univariado que se resumió mediante porcentajes. Se utilizó la prueba de la ji cuadrada para validar o rechazar la hipótesis según la cual la posición asignada por la población a los objetivos del SS es la misma, sin importar cuáles fueran las variables utilizadas en la comparación, y se desarrolló un modelo de regresión logística multinomial (politómica) para correlacionar el efecto de las variables independientes empleadas en el estudio, en relación con la importancia asignada por la población a los objetivos del SS. La categoría de referencia del modelo fue el objetivo de mejorar la salud de la población. El análisis se realizó con el paquete estadístico stata versión 7.0. RESULTADOS: El 31.8 por ciento de la población de estudio considera que mejorar el trato dentro del sistema de salud es el objetivo más importante . En el área rural, 31.46 por ciento de la población piensa que el objetivo más importante es mejorar la salud, un resultado relacionado con la autopercepción del estado de salud actual y la falta de atención médica...

Evaluación del gasto en la construcción de unidades de salud: ejemplo de participación comunitaria / Expenditure evaluation of the construction of health units: example of community participation

OBJETIVO: Demostrar los beneficios económicos de la participación comunitaria en la construcción de unidades de salud. MATERIAL Y MÉTODOS: Se realizó una evaluación de la eficiencia del gasto en la construcción de unidades de salud. Se comparó el gasto/m² y los tiempos de construcción de cada una de las 21 unidades auxiliares de salud y los 81 centros de salud rural dispersos edificados por el Programa de Apoyo a los Servicios de Salud para Población Abierta a través de tres modalidades de construcción: licitación pública nacional, invitación restringida y participación comunitaria. Este gasto también se comparó con el gasto monetario de otras unidades de salud similares edificadas a través de los programas normales de obra de otras instituciones. Se desarrolló un análisis univariado utilizando estadísticas no paramétricas y se diseñó un modelo matemático de ajuste a normal (bootstrapping) para analizar el gasto/m². RESULTADOS: La mediana de gasto/m² y de tiempos de entrega en las unidades auxiliares de salud y de gasto/m² para los centros de salud rural dispersos fue menor cuando se empleó la participación comunitaria. Los gastos/m² de las unidades construidas por el Programa de Apoyo a los Servicios de Salud para Población Abierta, sobre todo con participación comunitaria, fueron considerablemente más eficientes que los reportados por las obras de otros programas de construcción. CONCLUSIONES: El uso de la participación comunitaria en la construcción de unidades auxiliares de salud y todos los centros de salud rural dispersos permite disminuir considerablemente el monto de recursos invertidos por m² y mejorar los tiempos de construcción en relación con la licitación pública nacional y la invitación restringida. La construcción de unidades de salud bajo las condiciones generadas por el Programa de Apoyo a los Servicios de Salud para la Población Abierta permitiría mejorar los gastos/m² en relación con otros programas de construcción...

OBJECTIVE: Demonstrate the economic benefits that community participation may render in the construction of health units. MATERIALS AND METHODS: The purpose of this study was to analyze the efficiency in the construction of 21 auxiliary health units and 81 rural health built through the Program to Support the Development of Health Services for the Non-Insured Population (PASSPA) through three different construction models (national public bidding, restricted invitation and community participation). Comparisons were also made with the units built through regular construction procedures of the Ministry of Health and other institutions. To evaluate the expenditure/m², a univariate analysis using non-parametric statistics and a mathematical model of bootstrapping were used. RESULTS: The median expenditure/m² and the delivery times for auxiliary health units, and the median expenditure/m² for rural health units were smaller when using community participation. The expenditure/m² of those units built through PASSPA was considerably lower than that of health units built through regular construction procedures. CONCLUSIONS: The use of community participation in the construction of auxiliary health units and rural health units may impact positively the resource investment and the delivery times when compared with units built through national public biddings and restricted invitations. The possibility of using community participation in other health activities (supervision, maintenance) should be evaluated.

[Expenditure evaluation of the construction of health units: example of community participation]. / Evaluación del gasto en la construcción de unidades de salud: ejemplo de participación comunitaria.

OBJECTIVE: Demonstrate the economic benefits that community participation may render in the construction of health units. MATERIALS AND METHODS: The purpose of this study was to analyze the efficiency in the construction of 21 auxiliary health units and 81 rural health built through the Program to Support the Development of Health Services for the Non-Insured Population (PASSPA) through three different construction models (national public bidding, restricted invitation and community participation). Comparisons were also made with the units built through regular construction procedures of the Ministry of Health and other institutions. To evaluate the expenditure/m2, a univariate analysis using non-parametric statistics and a mathematical model of bootstrapping were used. RESULTS: The median expenditure/m2 and the delivery times for auxiliary health units, and the median expenditure/m2 for rural health units were smaller when using community participation. The expenditure/m2 of those units built through PASSPA was considerably lower than that of health units built through regular construction procedures. CONCLUSIONS: The use of community participation in the construction of auxiliary health units and rural health units may impact positively the resource investment and the delivery times when compared with units built through national public biddings and restricted invitations. The possibility of using community participation in other health activities (supervision, maintenance) should be evaluated. The English version of this paper is available at:http://www.insp.mx/salud/index.html.