Svetlana V Doubova1, Ingrid Patricia Martinez-Vega2, Claudia Infante-Castañeda3, Carlos E Aranda-Flores4, Felicia M Knaul5,6,7,8, Ricardo Pérez-Cuevas9. 1. Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico. svetlana.doubova@gmail.com. 2. Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico. 3. Institute of Social Research, National Autonomous University of Mexico, Mexico City, Mexico. 4. Servicio de Oncología, Hospital General de México "Dr. Eduardo Liceaga", Ciudad de Mexico, México. 5. Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA. 6. Department of Public Health Sciences, Leonard M. Miller School of Medicine, Miami, FL, USA. 7. Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL, USA. 8. Tómatelo a Pecho & Mexican Health Foundation (FUNSALUD), Mexico City, Mexico. 9. Division of Social Protection and Health, Jamaica Country Office, Interamerican Development Bank, Kingston, Jamaica.
Abstract
PURPOSE: To evaluate educational and health insurance-related inequalities in supportive care (SC) needs and quality of patient-centered care (PCC) for cancer patients in Mexico. METHODS: We conducted a cross-sectional survey in one Mexican Institute of Social Security (IMSS) and one Ministry of Health (MoH) oncology hospital in Mexico City. Formal labor market workers and their families have access to social health insurance that IMSS provides, while unemployed and informal workers receive care at the MoH. The study population comprised breast, colorectal, prostate, and hematologic cancer patients, aged ≥ 18 years, who attended outpatient consultations. Patients responded a short-form SC-needs questionnaire and a quality of PCC questionnaire. We used multiple logistic regression models to determine the independent association between educational attainment and high SC-needs and quality of PCC after controlling for sociodemographic and clinical covariates. RESULTS: We included 1058 IMSS and 606 MoH cancer patients. MoH patients perceived higher SC-needs and lower quality of PCC than IMSS patients. MoH patients with low education had a greater probability of high psychological and health system SC needs and lower likelihood of being informed for treatment decision-making and care for their biopsychosocial needs. IMSS patients with low educational levels had lower probability of receiving timely care and clarity of information than those with high education. Receiving high-quality PCC was associated with decreased SC needs. CONCLUSION: Uninsured cancer patients with low educational attainment have higher SC-needs and receive lower quality of PCC than their counterparts. Health services should face these challenges to reduce inequalities in Mexico.
PURPOSE: To evaluate educational and health insurance-related inequalities in supportive care (SC) needs and quality of patient-centered care (PCC) for cancerpatients in Mexico. METHODS: We conducted a cross-sectional survey in one Mexican Institute of Social Security (IMSS) and one Ministry of Health (MoH) oncology hospital in Mexico City. Formal labor market workers and their families have access to social health insurance that IMSS provides, while unemployed and informal workers receive care at the MoH. The study population comprised breast, colorectal, prostate, and hematologic cancerpatients, aged ≥ 18 years, who attended outpatient consultations. Patients responded a short-form SC-needs questionnaire and a quality of PCC questionnaire. We used multiple logistic regression models to determine the independent association between educational attainment and high SC-needs and quality of PCC after controlling for sociodemographic and clinical covariates. RESULTS: We included 1058 IMSS and 606 MoH cancerpatients. MoH patients perceived higher SC-needs and lower quality of PCC than IMSS patients. MoH patients with low education had a greater probability of high psychological and health system SC needs and lower likelihood of being informed for treatment decision-making and care for their biopsychosocial needs. IMSS patients with low educational levels had lower probability of receiving timely care and clarity of information than those with high education. Receiving high-quality PCC was associated with decreased SC needs. CONCLUSION: Uninsured cancerpatients with low educational attainment have higher SC-needs and receive lower quality of PCC than their counterparts. Health services should face these challenges to reduce inequalities in Mexico.
Entities:
Keywords:
Mexico; Quality of patient-centered care; Social inequalities; Supportive care needs