Old principles, persisting challenges: Maternal health care market alignment in Mexico in the search for UHC

Abstract

The purpose of this study is to analyze the alignment of supply and demand for antenatal care (ANC) in Mexico based on the definition of access provided by Donabedian: the "degree of adjustment" between resources and needs. Alignment was studied in the teenage and adult population of Mexico that lacked conventional social security between 2008 and 2015, a period of expanding financial resources for health and public health insurance coverage. Spatial econometric methods were used to analyze data from the Ministry of Health on the supply and demand for ANC in 2,314 municipalities (94% of all municipalities in Mexico). During this period, the relative weight of ANC demand among adolescents increased 37% while the production of antenatal consultations for adolescent and adult women remained unchanged. Bivariate spatial analyses of correlation between supply and demand for ANC services yielded a minimal spatial correlation, or lack of territorial correspondence, between supply and demand among women in both age groups. Spatial econometric analysis confirmed a non-significant association between supply and demand for ANC services. Our findings suggest the existence of misalignment between supply and demand for these services. This requires a reassessment of the management and delivery of ANC services at the local level in order to increase effective coverage and improve the overall performance of the health system.

Fig 1. Evolution of municipal supply and demand for antenatal consultations (average %, 2008–2015), Mexico.

Fig 2. Supply and demand for antenatal consultations at the municipal level, Mexico, 2015.

Note: Elaborated by the author. Public information sources: Information sub-system on births (SINAC) and National Health Information System (SINAIS). This figure was elaborated using the statistical program Stata MP v13.2.

Fig 3. Bivariate spatial correlation between supply and demand for antenatal consultations at the municipal level, Mexico, 2015.

Note: Estimates were based on the five nearest neighbors and included 10,000 shocks. Elaborated by the author using GeoDa.