Svetlana V Doubova1, Víctor Hugo Borja-Aburto2, Germán Guerra-Y-Guerra3, V Nelly Salgado-de-Snyder4, Miguel Ángel González-Block5. 1. Epidemiology and Health Services Research Unit, CMN Siglo XXI, Mexican Institute of Social Security, Av. Cuauhtemoc 330, Mexico City 06720, Mexico. 2. Unidad de Salud Pública, Instituto Mexicano del Seguro Social, Hamburgo 18, Mexico City 06700, Mexico City, Mexico. 3. Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Av. Universidad #655, Santa María Ahuacatitlán, 62100 Cuernavaca, Mor., México. 4. Instituto Nacional de Salud Pública, Av. Universidad #655, Santa María Ahuacatitlán, 62100 Cuernavaca, Mor., México. 5. Cátedra PwC de Investigación en Sistemas de Salud, Facultad de Ciencias de la Salud, Universidad Anáhuac, Av Universidad Anáhuac #46, Lomas Anahuac, 52786 Naucalpan de Juárez, Méx., Mexico.
Abstract
OBJECTIVES: The Mexican Institute of Social Security (IMSS) provides a package of health, economic and social benefits to workers employed in private firms within the formal labour market and to their economic dependants. Affiliates have a right to these benefits only while they remain contracted, thus posing a risk for the continuity of healthcare. This study evaluates the association between the time (in days) without the right to healthcare due to job loss in the formal labour market and the quality of healthcare and clinical outcomes among IMSS affiliates with Type 2 diabetes mellitus (T2DM). DESIGN: Retrospective cohort study 2013-2015. SETTING: Six IMSS family medicine clinics (FMC) in Mexico City. PARTICIPANTS: T2DM patients (n = 27 217) affiliated with job-related health insurance and at least one consultation with a family doctor during 2013. SOURCE OF INFORMATION: IMSS affiliation department database and electronic health records and clinical laboratory databases. MAIN OUTCOME MEASURE(S): Quality of the processes (eight indicators) and outcomes (three indicators) of healthcare. RESULTS: The results indicated that losing IMSS right to healthcare is frequent, occurring to one-third of T2DM patients during the follow-up period. The time without the right to healthcare in the observed period was of 120 days on average and was associated with a 43.2% loss of quality of care and a 19.2% reduction in clinical outcomes of T2DM. CONCLUSION: Policies aimed at ensuring access and continuity of care, regardless of job status, are critical for improving the quality of processes and outcomes of healthcare for diabetic patients.
OBJECTIVES: The Mexican Institute of Social Security (IMSS) provides a package of health, economic and social benefits to workers employed in private firms within the formal labour market and to their economic dependants. Affiliates have a right to these benefits only while they remain contracted, thus posing a risk for the continuity of healthcare. This study evaluates the association between the time (in days) without the right to healthcare due to job loss in the formal labour market and the quality of healthcare and clinical outcomes among IMSS affiliates with Type 2 diabetes mellitus (T2DM). DESIGN: Retrospective cohort study 2013-2015. SETTING: Six IMSS family medicine clinics (FMC) in Mexico City. PARTICIPANTS: T2DM patients (n = 27 217) affiliated with job-related health insurance and at least one consultation with a family doctor during 2013. SOURCE OF INFORMATION: IMSS affiliation department database and electronic health records and clinical laboratory databases. MAIN OUTCOME MEASURE(S): Quality of the processes (eight indicators) and outcomes (three indicators) of healthcare. RESULTS: The results indicated that losing IMSS right to healthcare is frequent, occurring to one-third of T2DM patients during the follow-up period. The time without the right to healthcare in the observed period was of 120 days on average and was associated with a 43.2% loss of quality of care and a 19.2% reduction in clinical outcomes of T2DM. CONCLUSION: Policies aimed at ensuring access and continuity of care, regardless of job status, are critical for improving the quality of processes and outcomes of healthcare for diabetic patients.
Authors: Germán Guerra; Emilio Gutiérrez-Calderón; Nelly Salgado de Snyder; Víctor Hugo Borja-Aburto; Adolfo Martínez-Valle; Miguel Ángel González-Block Journal: BMC Health Serv Res Date: 2018-06-15 Impact factor: 2.655