Assessment of surgical capacity in Chiapas, Mexico: a cross-sectional study of the public and private sector

Abstract

IntroductionSurgical, anaesthesia and obstetric (SAO) care are essential, life-saving components of universal healthcare. In Chiapas, Mexico’s southernmost state, the capacity of SAO care is unknown. This study aims to assess the surgical capacity in Chiapas, Mexico, as it relates to access, infrastructure, service delivery, surgical volume, quality, workforce and financial risk protection.MethodsA cross-sectional study of Ministry of Health public hospitals and private hospitals in Chiapas was performed. The translated Surgical Assessment Tool (SAT) was implemented in sampled hospitals. Surgical volume was collected retrospectively from hospital logbooks. Fisher’s exact test and Mann-Whitney U test were used to compare public and private hospitals. Catastrophic expenditure from surgical care was calculated.ResultsData were collected from 17 public hospitals and 20 private hospitals in Chiapas. Private hospitals were smaller than public hospitals and public hospitals performed more surgeries per operating room. Not all hospitals reported consistent electricity, running water or oxygen, but private hospitals were more likely to have these basic infrastructure components compared with public hospitals (84% vs 95%; 60% vs 100%; 94.1% vs 100%, respectively). Bellwether surgical procedures performed in private hospitals cost significantly more, and posed a higher risk of catastrophic expenditure, than those performed in public hospitals.ConclusionCapacity limitations are greater in public hospitals compared with private hospitals. However, the cost of care in the private sector is significantly higher than the public sector and may result in catastrophic expenditures. Targeted interventions to improve the infrastructure, workforce availability and data collection are needed.

Rethinking referral systems in rural chiapas: A mixed methods study

“…However, seeking care from the private sector has its own accompanying fees, making expendable resources key to accessing care. A 2020 study found surgery in the private sector significantly more likely to cause catastrophic expenditure [ 14 ]. These costs put patients at risk of joining the over 81 million people who experience catastrophic expenditure from surgical costs annually, often leading to generational poverty through the selling of essential property [ 29 ].…”

“…Despite universal health coverage, large disparities exist in healthcare access and quality in the southern state of Chiapas, where roughly 30% of the population lives in extreme poverty [ 12 , 13 ]. In recent studies, the public surgical system in Chiapas was found to have significant capacity limitations in areas such as infrastructure, diagnostic capabilities, and workforce [ [14] , [15] , [16] ].…”

Assessment of essential surgical and anaesthesia care capacity: a cross-sectional study in five Pacific Island Countries

“…In accordance with previous literature, we categorised equipment and consumables into anaesthetic equipment, surgical equipment, and consumables (S2). 34 , 35 Descriptive comparisons were made without statistical inference.…”