RESUMO
OBJECTIVE: This study explored a number of factors that determine the professional status of physicians in Mexico. METHODS: Using structural equation modelling techniques, causal models were developed to investigate the determinants of professional status within the medical field. RESULTS: The findings suggest that the proposed stratification process in the causal model has empirical support. In the prestige dimension, there is an adscriptive effect of gender, the resultant gender segregated the Mexican medical profession; in addition the achievement effects of medical education and work history within significant occupational and bureaucratic structures. In the economic dimension, the ascriptive effect of gender and the resultant differential in income and job opportunities of female physicians exist. CONCLUSIONS: Although social origin seems to have a weak effect on the dimensions of professional status, it is suggested that both medical education and employment history were both significant positive determinants of professional status in the Mexican medical system. On the other hand, there are still significant gender inequities in the stratification structure of the medical profession.
Assuntos
Médicos , Classe Social , Adulto , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Modelos EstatísticosRESUMO
OBJECTIVE: To evaluate the effect of a quality-monitoring program on the occurrence of sentinel events and on attitudes and behaviors of personnel's responses in a Non-Governmental-Organization (NGO). MATERIAL AND METHODS: Between 1998 and 1999, a quasi-experimental design of the before-after type was conducted in 13 NGO clinics. Analysis of changes in attitudes and behaviors consisted in differences of means and analysis of variance between groups. RESULTS: The number of sentinel events decreased from 32 events detected before the quality-monitoring program to only 2 after it. Attitudes and behaviors improved, with differences of means of +1.1 and +1.2 (p < 0.05). CONCLUSIONS: The quality-monitoring program achieved the expected effects. It is noteworthy that attitudes and behaviors to prevent the occurrence of sentinel events were more prevalent after the intervention.
Assuntos
Atenção à Saúde/normas , Organizações/normas , Avaliação de Programas e Projetos de Saúde , Gestão da Qualidade Total , Humanos , MéxicoRESUMO
The present work pretend to describe the development achieved in the field of health technology assessment and to propose a set of criteria to evaluate them, with the intention that it will lead to the development of health programs and policy with a tendency to maximize effectiveness, efficiency and quality, within a frame of increasing needs and scarce technical and economic resources for health care. For this work, a comprehensive review was carried out about the background of health technology adoption in our country, and the context by which to evaluate the accessibility and utilization of the health technology. In the section for technology assessment, it is propose a method to evaluate based upon the natural history of disease, that is, the traditional form of health assessment is restricted to a cross section in time (vertical evaluation), and in this study the authors propose a model with a horizontal approach, that should offer as its main virtues the development of guidelines with regards to prevention, diagnosis and treatment, in addition to cost containment, in support to a more effective and higher quality medical practice.
Assuntos
Nível de Saúde , Ciência de Laboratório Médico , Países em Desenvolvimento/economia , Métodos Epidemiológicos , Estudos de Avaliação como Assunto , Previsões , Acessibilidade aos Serviços de Saúde , Humanos , Serviços de Informação , Ciência de Laboratório Médico/economia , México , Modelos Teóricos , Pesquisa , Transferência de TecnologiaRESUMO
Public health problems have been analyzed over time using different approaches involving a variety of methodological and theoretical models. The classical epidemiological model and the social epidemiological model are two examples of models used in public health research. Although each of these models covers a whole range of public research approaches, it is possible to identify the different theoretical and methodological criteria and the different ideological assumptions on which they are based. The objective of this article is to make a comparison of the criteria used by the classical and social epidemiological models in the study of public health problems, with special emphasis on the study of obesity. This comparison shows that the knowledge generated by studies carried out under each of these models is rather different, as an effect of the different theoretical, methodological and ideological criteria used by each model. However, far from being contradictory, the knowledge generated by each model can complement that generated by the other. Finally, the inclusion of social sciences as a tool for the analysis of public health problems, specifically the problem of obesity, is discussed.
Assuntos
Obesidade/epidemiologia , Saúde Pública , Métodos Epidemiológicos , Humanos , Ciências SociaisRESUMO
One of the primary obstacles in the implementation of continuous quality improvement (CQI) programmes in developing countries is the lack of timely and appropriate information for decentralized decision-making. The integrated quality information system (QIS) described herein demonstrates Mexico's unique effort to package four separate, yet mutually reinforcing, tools for the generation and use of quality-related information at all levels of the Mexican national health care system. The QIS is one element of the continuous quality improvement programme administered by the Secretariat of Health in Mexico. Mexico's QIS was designed to be flexible and capable of adapting to local needs, while at the same time allowing for the standardization of health care quality assurance indicators, and subsequent ability to measure and compare the quality performance of health facilities nationwide. The flexibility of the system extends to permit the optimal use of available data by health care managers at all levels of the health care system, as well as the generation of new information in important areas often neglected in more traditional information systems. Mexico's QIS consists of four integrated components: 1) a set of client and provider surveys, to assess specific issues in the quality of health services delivered; 2) client and provider national satisfaction surveys; 3) a sentinel health events strategy; and 4) a national Comparative Performance Evaluation System, for use by the Secretariate of Health for the quality assessment of state and provincial health care services (internal benchmarking). The QIS represents another step in Mexico's ongoing effort to use data for effective decision-making in the planning, monitoring and evaluation of services delivered by the national health care system. The design and application of Mexico's QIS provides a model for decentralized decision-making that could prove useful for developing countries, where the effective use of quality indicators is often limited. Further, the system could serve as a mechanism for motivating positive change in the way information is collected and used in the process of ensuring high quality health care service delivery.
Assuntos
Sistemas de Informação Administrativa , Administração em Saúde Pública/normas , Gestão da Qualidade Total , Benchmarking , Coleta de Dados , Países em Desenvolvimento , Estudos de Avaliação como Assunto , México , Estudos de Casos Organizacionais , Indicadores de Qualidade em Assistência à SaúdeRESUMO
OBJECTIVE: To determine the direct financial requirements for providing health care to the elderly in Mexico along with an estimation of the current expenditures from services provided to this same population. MATERIAL AND METHODS: Health care needs for the elderly were estimated from the censuses and the database of the National Health Survey II. In addition, service use trends for the aged were obtained from health sector statistical yearbooks. Finally, the amounts of expenditures were estimated by two methods: a) using a formula that considers hospital discharges, daily bed costs and length of stay; and b) inferring hospital expenditures and ambulatory visits from the numbers of hospital discharges. RESULTS: Currently health care needs of the aged outnumber the amount of resources and the capacity of the health care sector to meet these needs. Our estimates for the year 1994 show that 4.9% of the total budget available to public health care institutions was dedicated to hospital services provided to the elderly. CONCLUSIONS: In Mexico, the aged population health needs are already a priority, due to the particular nature of their needs and demand. Taking care of this population demands an important fraction of the resources spent in hospital services. To correctly plan and allocate resources for providing health care to this population developing a research agenda is an important requirement.
Assuntos
Idoso , Atenção à Saúde/economia , Idoso de 80 Anos ou mais , Financiamento Governamental , Necessidades e Demandas de Serviços de Saúde , Hospitalização/economia , Humanos , México , Pessoa de Meia-IdadeRESUMO
Reform is probably the most frequently used term when discussing health care systems. The literature is broad and general, with topics ranging from reasons for carrying out reform, through discussion and the meaning of the reform, to discussions of methods for reform in developing countries. Interest has been centered more on the definition of content and less on the processes of implementation. Implications in terms of changes in the requirements of health facilities and human resources have been only superficially addressed. This paper presents a conceptual framework to discuss the main issues involved in reform of the health care systems and the shifts in needs of human resources. Assessment of the ways in which reform affects the medical labor market require the application of a conceptual framework that enables us to focus more on process than content. In the organizational change literature, both in theory and practice, human resources have been found critical for the institutionalization of organizational change. They are also critical for assessing health care reform.
Assuntos
Reforma dos Serviços de Saúde/organização & administração , Mão de Obra em Saúde , Países em Desenvolvimento , Necessidades e Demandas de Serviços de Saúde , Humanos , Marketing de Serviços de Saúde , México , Modelos Organizacionais , Inovação OrganizacionalRESUMO
A study was carried out in 1970 on the distribution of medical personnel in Mexico. At that time an unequal distribution of physicians was detected, but not emphasized given the general shortage of physicians in the country. At the present time, the situation has changed. In this article the analysis of the 1990 census data using traditional indicators of availability of physicians in the country, as well as indirect criteria of physician requirements is presented. In the year of reference there were 157,407 physicians in the country, with a national average of 673 persons per physician. The distribution of physicians by state showed a great deal of variation in the number of persons per physician. For example, the state of Chiapas has 1,642 inhabitants per physician, whereas the Federal District has 292. The relation between trained and employed physicians shows another important phenomenon: there is a high percentage of physicians that do not practice clinical medicine (19.4%). Nevertheless, the number of physicians almost tripled the growth experienced by the general population, and important differences among and within states do persist. Furthermore, a new paradoxical effect has emerged, the presence of underemployment and unemployment of physicians, even in communities with greater needs for medical care. This indicates that the strategy of training more physicians has not solved the problems of accessibility and coverage, but in fact has fostered new problems and perhaps greater inequalities.
Assuntos
Médicos/provisão & distribuição , Demografia , Emprego/estatística & dados numéricos , Humanos , México , Médicos/estatística & dados numéricosRESUMO
Health management has become a fashion and it is now common to talk about strategic or service management, or of total quality management applied to health systems. However, all these elements of business management are being translated to health systems without a previous analysis on the implicit health model and the rationality of the prevalent production functions, which can lead to a higher level of efficiency but with an inadequate use of resources. This paper suggests the importance of integrating the advances in management and health sciences and proposes what are considered to be the conceptual basis for the design of a management tool geared to conduct local health systems with effectiveness, efficiency, quality and equity.
Assuntos
Serviços de Saúde Comunitária/organização & administração , Empreendedorismo/organização & administração , Empreendedorismo/tendências , Necessidades e Demandas de Serviços de Saúde/organização & administração , Modelos Organizacionais , Inovação OrganizacionalRESUMO
The training of health services administration professionals in Mexico has faced two main challenges. One the one hand, the need to have recognition as professionals, and on the other hand the difficulty to train individuals that are currently working as health care administrators. This article emphasizes a distance education strategy as an alternative to provide training to these type of personnel. A proposal developed as the second phase of the Advance Education Program on Health Administration (PROASA-II) is presented. It has the objective to strengthen local institutions to take responsibility for the future training of their professional administration staff. Once that this is started, we can begin to talk about the creation of a national system of manpower training in health administration and public health, that will support the decentralization and the appropriate training of the different levels of health administration in the country.