Navigation Links
Centralized health care more cost-effective, offers better access to preventive services
Date:9/14/2010

Families from rural Mexico who receive health care from centralized clinics run by the federal government pay up to 30 percent less in out-of-pocket expenses and utilize preventive services more often than those families who access decentralized clinics run by states, according to a study by researchers at the UCLA School of Public Health.

The findings are published in the September issue of the Journal of Social Science and Medicine and are currently available online.

The data were drawn from a comprehensive survey of 8,889 rural families from seven states in Mexico conducted in 2003 by Oportunidades, Mexico's principal anti-poverty program. The findings contradict the widely perceived notion that decentralized systems in which local knowledge and resources can be more effectively used to address local needs are superior to centralized organizations.

The study measured the effectiveness of centralized and decentralized providers using two measures: overall health expenditures by users (both centralized and decentralized providers offer free health care and drugs at rural clinics) and the utilization of preventive services (higher use reduces the cost of treating preventable conditions in the future).

Since centralized and decentralized organizations rarely operate within the same country during the same time period or cater to comparable populations, Mexico's health caredelivery system provides a unique opportunity to compare the two approaches side by side.

Starting the mid-1940s, the public safety net for Mexicans not covered by the Mexican Social Security Institute or other federal social security institutes was administered by the federal government. The government provided a limited bundle of cost-effective services, including primary and preventive care and basic hospitalization to the poorest rural areas of the country.

During the 1980s, the government undertook an ambitious decentralization plan that gave half the Mexican states oversight over these health services. A new administration interrupted the process, but it was restarted in the 1990s. Since then, both centralized and decentralized health care services have co-existed in 17 Mexican states without competing with one another.

The study revealed that households serviced by decentralized providers reported higher out-of-pocket health expenditures and lower utilization of preventive services, spending almost 40 percent more out-of-pocket and utilizing preventive care 7 percent less than households serviced by centralized providers. The households studied showed no differences in terms of age, years of schooling, family size, insurance status, employment, need and most community infrastructure measures.

Providers that were devolved to state governments during the first round of decentralization in the early '80s performed slightly better than providers decentralized in the '90s. This suggests that over time the performance of decentralized providers may improve.

"We find that the Mexican experience can be useful to other developing countries in Latin America (e.g. Chile or Brazil) and other areas of the developing world (e.g. China, Iran, Turkey) where relatively professional centralized governments have considered decentralization as a policy mechanism to reform their national health systems," said Arturo Vargas Bustamante, the study's lead investigator and an assistant professor of health services at the UCLA School of Public Health.

Vargas Bustamante suggests that the centralized providers have four attributes that may give them an advantage:

  • Type of service: Because the types of services provided to rural populations do not require a high degree of specialization and are relatively homogenous and less sensitive to local taste and variation, centralized providers may be able offer these services more efficiently.
  • Quality of care: Centralized providers have more public resources to provide better services and employ more incentives and monitoring to improve the quality of care. For example, centralized providers can offer more generous pensions and benefits to their employees, compared with the average decentralized provider.
  • Experience: In the three decades since decentralization began, centralized providers may have resolved functional issues that decentralized providers may still be tackling.
  • Local capacity: Even if local authorities are closer to their communities and are more familiar with their characteristics and limitations, they still need managerial skills to provide health services that require some level of expertise. If these skills are less developed among decentralized providers, they will not be able to perform better than centralized providers.

The study suggests that decentralization may be less effective because state governments do not always match the public resources that are taken away by the federal government.

The researchers note that the single advantage enjoyed by those served by decentralized clinics is access to health campaigns. These are useful in providing basic interventions such as vaccinations, screenings and health education. The study suggests that decentralized providers could reduce users' out-of-pocket costs by offering more mobile health services and strengthening the network of clinics where follow-up treatments would be available to people reached by health campaigns.


'/>"/>

Contact: Sarah Anderson
sanderson@ph.ucla.edu
310-267-0440
University of California - Los Angeles
Source:Eurekalert

Related medicine news :

1. Mental health leaves most costly disability to Canadian employers
2. Health Care Reform: Employees Face Greater Cost-Sharing
3. The cost of over-triage on our nations health system
4. 23rd ECNP Congress: Europes largest scientific meeting on mental health
5. University, government and philanthropic leaders converge in Seattle to advance global health
6. Low levels of formaldehyde in clothing unlikely to pose health risk
7. Team to study health effects of botanical estrogens
8. Low-Carb Diets Heavy on Meat May Raise Health Risks
9. Publication of World Health Report 2000 an act of remarkable courage, says school expert
10. Health Care Reform Helps Small Businesses Offer Coverage: Report
11. EMAS publishes position statements about the post-reproductive health of women
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/24/2016)... ... 24, 2016 , ... People across the U.S. are sharpening their pencils and ... essay contest in which patients and their families pay tribute to a genetic counselor ... National Society of Genetic Counselors (NSGC) Annual Education Conference (AEC) this September. , ...
(Date:6/24/2016)... ... June 24, 2016 , ... ... Investment Group (TGIG), has initiated cultivation and processing operations at its production facility, ... Pahrump, Nevada. , Puradigm is the manufacturer of a complete system of proactive ...
(Date:6/24/2016)... ... June 24, 2016 , ... Venture Construction Group (VCG) sponsors Luke’s ... June 20th at the Woodmont Country Club at 1201 Rockville Pike, Rockville, Maryland, 20852. ... helping service members that have been wounded in battle and their families. Venture Construction ...
(Date:6/24/2016)... ... 2016 , ... Finally, a bruise cream that really works. Originally designed ... into the post-surgical treatment plans of a variety of other procedures including, but not ... effective for bruising and causes a rapid resolution of bruising and inflammatory changes compared ...
(Date:6/24/2016)... , ... June 24, 2016 , ... Today, InhaleLabs.com ... the ingestion of their medication by matching users with high quality water pipes within ... pieces with no commitment. , Inhale was founded by two brothers, Nick and Mike ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... 2016 Dehaier Medical Systems Ltd. (NASDAQ: ... markets and sells medical devices and wearable sleep respiratory ... strategic cooperation agreement with Hongyuan Supply Chain Management Co., ... June 20, 2016, to develop Dehaier,s new Internet medical ... Dehaier will leverage Hongyuan Supply Chain,s sales platform to ...
(Date:6/24/2016)... 2016 According to a new ... Pen Needles, Safety Pen Needles), Needle Length (4mm, 5mm, ... Mode of Purchase (Retail, Non-Retail) - Trends & Global ... the market for the forecast period of 2016 to ... Billion by 2021 from USD 1.65 Billion in 2016, ...
(Date:6/24/2016)... 2016  Arkis BioSciences, a leading innovator in ... durable cerebrospinal fluid treatments, today announced it has ... is led by Innova Memphis, followed by Angel ... investors.  Arkis, new financing will accelerate the commercialization ... release of its in-licensed Endexo® technology. ...
Breaking Medicine Technology: