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Objective:: To analyze trends in inequality in financial protection and healthcare in Mexico between 2000 and 2012, using simple and complex measures., Materials and Methods:: Analysis of national health surveys 2000, 2006 and 2012, generating estimates of absolute and relative gaps and the slope index of inequality using imputated income as socioeconomic measure, and differences by sex, rural/urban residence, and ethnic background., Results:: Between 2000 and 2012, socioeconomic inequality in financial protection vanished, while it remains in healthcare access, with larger barriers to access healthcare among those in the lowest socioeconomic condition. These results are consistent with the differences by urban/rural residence and ethnic background., Conclusions:: The health reform in 2003, aiming to increase health insurance, resulted in the virtual elimination of socioeconomic inequality in financial protection, but there is still inequality in access to healthcare. Actions to eliminate access barriers related to quality of health services are urgent to promote effective access to healthcare.

Objective:: To analyze trends from 2000 to 2012 in socioeconomic inequalities in health related to diabetes and hypertension indicators in Mexico., Materials and Methods:: Cross-sectional analysis of three national health surveys (2000, 2006 and 2012), measuring inequality using absolute and relative gaps as well as the Slope Index of Inequality for diabetes and hypertension indicators., Results:: From 2000 to 2012, there is a reduction in the gap related to the prevalence of diagnosed diabetes and hypertension, with a parallel reduction in the inequality related to care for those conditions, while an inequality gradient on diabetes care remains., Conclusion:: While there is an evident progress in the reduction of inequalities for diabetes and hypertension diagnostic and care in Mexico, some inequalities remain. Given the contribution of these conditions to the burden of disease in the country, there is a need to strength the quality of health services that will promote effective access.

Objective:: To analyze inequalities in health care indicators of children 0 to 9 years old in Mexico reporting gap and gradient measures., Materials and Methods:: Cross-sectional analysis of national health surveys in 2000, 2006 and 2012, measuring absolute and relative gap measures as well as the Slope Index of Inequality for four health care indicators (vaccination, care for acute respiratory infections, care for acute diarrheal diseases, and care for accidents) with socioeconomic stratification, as well as absolute gaps by sex, urbanicity and ethnic background., Results:: Between 2000 and 2012, immunological equity was reached in Mexico, as well as elimination in the socioeconomic gap related to care for accidents; nevertheless, there is a persistent socioeconomic gap of care for acute respiratory infections that is also there regarding rural residence and indigenous population., Conclusion:: In Mexico, there is a trend to the elimination of socioeconomic differences in the probability of receiving adequate health care among children, although some socioeconomic gaps remain in particular related to provision of services that require more participation of health personnel. There is a need to ensure homogenous access to effective services for all.

Objective: To estimate the effectiveness of using standardized health vignettes to adjust self-reported health taking into account household and community variables to correct for systematic bias., Material and Methods: The national health survey "Evaluación del Desempeño 2002" (Mexican component of the World Health Survey) was used. This survey analyzed subject's health perception based on their responses to hypothetical questions referring to third parties in the vignettes within eight domains. Variations in responses were attributed to socio-demographic, socioeconomic, community, differences of the subjects. To assess those variations, an index for each domain was constructed and used as a variable in a series of linear regression models to estimate the relation between health perceptions, self-reported health, socioeconomic and socio-demographic characteristics., Results: The health perception index derived from the vignettes showed a positive, logarithmic correlation with household expenditure for each health domain, after controlling for socio-demographic, health and community characteristics. No relationship was found between the health status described in the vignettes and self-reported health status. In no case was the explanatory power above 10%., Conclusion: The low explanatory power of the models, and the lack of correlation between self reported health status and the health perception index, suggest that the variability in the vignettes responses cannot be explained by differences in self-reported health status or socioeconomic and socio-demographic characteristics. These results from Mexico suggest that vignette-based methods to correct for systematic variability in perception of own health status are of limited efficacy and reinforce the importance of collecting objective measures of health status in health surveys.

Investment in health has been proposed as a mechanism to promote upward social mobility. Previous analyses have reported inconsistent estimates of the returns to investment in health in Mexico based on different models for different years. We aim to estimate returns for Mexico using data from four time points Adult height and labor income are drawn from the periodical national health and nutrition surveys–a group of relatively standardized surveys—that are representative of individuals living in the country in 2000, 2006, 2012 & 2018. These surveys collect anthropometric measurements and information on individuals' labor income. We estimated Mincerian models separately for men and women using OLS, Heckman, instrumental variables, and Heckman with instrumental variables models. Our results indicate significant and positive returns to health for the four surveys, similar in magnitude across years for women and with variations for men. By 2018, returns to health were about 7.4% per additional centimeter in height for females and 9.3% for males. Investments in health and nutrition during childhood and adolescence that increase health capital–measured as adult height—may promote social mobility in Mexico and similar countries to the extent that these investments differentially increase health capital among the poor. [ABSTRACT FROM AUTHOR]

Objective. To estimate the HIV seroprevalence among Mexicans aged l5 to 49 years old and living in households, and to describe the profile of serorreactive individuals. Materials and methods. Cross-sectional study with a national probabilistic sample of individuals aged l5 to 49 years with behavioral data from direct interview (face-to-face) at households and HIV screening using capillary blood collected from the same individuals. Results. A seroprevalence of 0.15% (95%CI 0.09-0.21) was estimated for Mexicans aged 15 to 49; seroprevalence among women was 0.07% (95%CI 0.03-0.11) and 0.24% (95%CI 0.11-0.36) for men. HIV serorreactive population is composed of younger men, with a higher socioeconomic level compared to the general population, and with a higher insurance coverage-social protection on health in general and social security in particular. Only 50% of the serorreactive individuals may be aware of their status as living with HIV. Conclusions. The estimated HIV seroprevalence in the NHNS 2012 suggests a stable pattern since 2000. The estimated prevalence among individuals 15 to 49 years was adjusted both for selection bias correction and to include MSM estimations (under the assumption that MSM is a population hard to reach in a household survey), resulting in a total seroprevalence of 0.23% and an estimated number of people with HIV of 140 000. [ABSTRACT FROM AUTHOR]

Background Effective access measures are intended to reflect progress toward universal health coverage. This study proposes an operative approach to measuring effective access: in addition to the lack of financial protection, the willingness to make out-of-pocket payments for health care signifies a lack of effective access to pre-paid services. Methods Using data from a nationally representative health survey in Mexico, effective access at the individual level was determined by combining financial protection and effective utilization of pre-paid health services as required. The measure of effective access was estimated overall, by sex, by socioeconomic level, and by federal state for 2006 and 2012. Results In 2012, 48.49% of the Mexican population had no effective access to health services. Though this represents an improvement since 2006, when 65.9% lacked effective access, it still constitutes a major challenge for the health system. Effective access in Mexico presents significant heterogeneity in terms of federal state and socioeconomic level. Conclusions Measuring effective access will contribute to better target strategies toward universal health coverage. The analysis presented here highlights a need to improve quality, availability, and opportuneness (location and time) of health services provision in Mexico. [ABSTRACT FROM AUTHOR]

Objective. To describe the socioeconomic (SE) indicator developed for the analysis of the National Health and Nutrition Survey 2012 (NHNS 2012) and its validation. Materials and methods. The SE indicator was generated imputing deciles of income level to the households on the NHNS 2012, using demographic and socioeconomic characteristics, and based on the National Income and Expenditure Survey 2010. As a validation, distribution of different household characteristics related to SE status was described by predicted decile. Results. The resulting SE indicator adequately describes heterogeneity on standard socioeconomic variables, as schooling years of the head of household, income, access to services, and household assets. Conclusion. The socioeconomic heterogeneity captured by the proposed SE indicator allows identifying variability and gaps on health outcomes and programs coverage related to socioeconomic level. [ABSTRACT FROM AUTHOR]

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