BackgroundIn 2006, the Mexican government launched the Fund for Protection Against Catastrophic Expenditures (FPGC) to support financially healthcare of high cost illnesses. This study aimed at answering the question whether FPGC improved coverage for cancer care and to measure survival of FPGC affiliated children with cancer.ProcedureA retrospective cohort study (2006–2009) was conducted in 47 public hospitals. Information of children and adolescents with cancer was analyzed. The coverage was estimated in accordance with expected number of incident cases and those registered at FPGC. The survival was analyzed by using Kaplan–Meier survival curves and Cox proportional hazards regression modeling.ResultsThe study included 3,821 patients. From 2006 to 2009, coverage of new cancer cases increased from 3.3% to 55.3%. Principal diagnoses were acute lymphoblastic leukemia (ALL, 46.4%), central nervous system (CNS) tumors (8.2%), and acute myeloid leukemia (AML, 7.4%). The survival rates at 36 months were ALL (50%), AML (30.5%), Hodgkin lymphoma (74.5%), Non-Hodgkin lymphoma (40.1%), CNS tumors (32.8%), renal tumors (58.4%), bone tumors (33.4%), retinoblastoma (59.2%), and other solid tumors (52.6%). The 3-year overall survival rates varied among the regions; children between the east and south-southeast had the higher risks (hazard ratio 3.0; 95% CI: 2.3–3.9) and 2.4; 95% CI: 2.0–2.8) of death from disease when compared with those from the central region.ConclusionFPGC has increased coverage of cancer cases. Survival rates were different throughout the country. It is necessary to evaluate the effectiveness of this policy to increase access and identify opportunities to reduce the differences in survival.

Diseño de la evaluación 2009 del programa Seguro Médico para una Nueva Generación. Salud Publica Mex 2012;54 supl 1:S11-S19. ResumenObjetivo. Describir el abordaje de métodos mixtos que se utilizó para evaluar el SMNG Seguro Médico para una Nueva Generación. Material y métodos. la evaluación integral del Programa se llevó a cabo en cuatro áreas clave: 1) el diseño del SMNG, 2) el estado de salud y las características sociodemográficas de los niños afiliados, 3) el desempeño del SMNG mediante la medición de la cobertura y de procesos clave, 4) los gastos en salud de la familia. La metodología mixta combina enfoques de investigación cuantitativa y cualitativa y la recolección y análisis de datos. La evaluación incluyó la revisión de bases de datos y de expedientes clínicos y la recolección de datos empíricos mediante entrevistas a profundidad con actores clave, una encuesta de hogares en todo el país y cuestionarios a personal de salud. Conclusión. Los resultados sirven como referencia sobre el estado de salud de los niños afiliados al SMNG y de las condiciones actuales del programa; además permiten identificar áreas clave que pueden abordarse para mejorar la calidad, eficiencia y eficacia del SMNG. AbstractObjective. To describe the mixed-method approach to evaluate the Medical Insurance for a New Generation (Seguro Médico para una Nueva Generación, SMNG). Materials and Methods. The program has been comprehensively evaluated. It has four key domains: 1) SMNG design; 2) children's health status and socio-demographic characteristics; 3) performance by measuring coverage, efficiency and productivity; 4) family health expenditure. Quantitative and qualitative research approaches have been used. This included reviews of existing databases and clinical charts, collection of empirical data through in-depth interviews with healthcare providers, and a nation-wide household survey. Conclusion. The results should serve as baseline data of the health status of SMNG children and the current staus of the program. Artículo originAl S12salud pública de méxico / vol. 54, suplemento 1 de 2012Pérez-CuevasR y col.

Jasso-Gutiérrez L, Durán-Arenas L,Flores-Huerta S, Cortés-Gallo G. Recommendations to improve healthcare of neonates with respiratory insufficiency beneficiaries of Seguro Popular. Salud Publica Mex 2012;54 suppl 1:S57-S64. AbstractObjective. To evaluate the structure and processes of care of neonatal intensive care units (NICU) providing health care to neonates with respiratory insufficiency, and financed by Seguro Popular. Materials and Methods. A cross-sectional design was used; 21 NICU were included. Information was collected from four sources: Seguro Popular database, selfapplicable interviews to medical staff, structure and processes format, and reviews of clinical charts. Variables: structure, processes of care, drug supplies, training, and neonates' clinical conditions. Results. The analysis of the database included 9 679 newborns. The respiratory disorders were transitory tachypnea, non-specific respiratory insufficiency, respiratory distress syndrome, (RDS) perinatal asphyxia, and meconium aspiration syndrome. 90% of NICU'S directors considered that drug supply was good, whereas only 16% of neonatologist had this opinion. 58.5% of neonates with RDS had <37 gestation weeks. 34.2% with RDS were prescribed alveolar surfactant; 51% received dosages above recommended standards. Conclusions. Recommendations to improve infrastructure and care processes are issued.Key words: neonate respiratory insufficiency; respiratory distress syndrome; health insurance; neonatal intensive care unit; quality of care; neonatal mortality; Mexico Jasso-Gutiérrez L, Durán-Arenas L, Flores-Huerta S, Cortés-Gallo G. Recomendaciones para mejorar el cuidado de la salud de neonatos con insuficiencia respiratoria beneficiarios del Seguro Popular. Salud Publica Mex 2012;54 supl 1:S57-S64.

Objective. To describe the Medical Insurance for a New Generation (SMNG) as key public policy aimed at improving health care services for children under the age of five years in Mexico. Materials and methods. This paper analyzes interrelated aspects of public policies to provide health care to Mexican children: a) the demographic and health status of children, with emphasis on the wide disparities between children of varying demographics; b) the relationship of the main functions of a health care system: financing, equity, access and quality, with the provision of health care for children; c) the architecture of the Medical Insurance for a New Generation. Conclusion. SMNG is a program that can be instrumental in lowering infant mortality and alleviating the burden of families to care for sick children by improving access, quality of care and equity.

The first evaluation of the Medical Insurance for a New Generation program (SMNG) was conducted in 2009. A mixed-method approach was used to obtain a comprehensive picture of SMNG members and the program itself. The evaluation comprised: 1) Program design; 2) Social and health conditions of its members; 3); Evaluation of SMNG's performance by measuring coverage, productivity and efficiency; 4) Families health expenditures. The lessons learned for the program are that SMNG is focused on a vulnerable segment of the population with pervasive unmet health needs; prevalence of malnutrition, anemia and other conditions remains high. Further efforts are necessary to deploy the program where it is most needed, particularly in rural areas; most of its members are urban dwellers. However, more needs to be done to educate members about the importance of preventive care and to build the capability of health providers to provide high quality care. Families are still experiencing hardship to provide medical care to their children, so additional efforts are needed to decrease out-of-pocket and catastrophic expenditures. The lessons learned for the evaluation allow concluding that this first evaluation set the groundwork for better-targeted subsequent interventions and evaluations aimed at showing the impact of SMNG to bridge existing gaps in equity, access, coverage, and health status of Mexican children.