Navigating and Circumventing a Fragmented Health System: The Patient's Pathway in the Sierra Madre Region of Chiapas, Mexico

Abstract

Mexico has implemented several important reforms in how health care for its poorest is financed and delivered. Seguro Popular, in particular, a recently implemented social insurance program, aims to provide new funds for a previously underfunded state-based safety net system. Through in-depth ethnographic structured interviews with impoverished farmers in the state of Chiapas, this article presents an analysis of Seguro Popular from the perspective of a highly underserved beneficiary group. Specific points of tension among the various stakeholders--the government system (including public clinics, hospitals, and vertical programs), community members, private doctors, and pharmacies--are highlighted and discussed. Ethnographic data presented in this article expose distinct gaps between national health policy rhetoric and the reality of access to health services at the community level in a highly marginalized municipality in one of Mexico's poorest states. These insights have important implications for the structure and implementation of on-going reforms.

The Impact of Social Health Insurance on Diabetes and Hypertension Process Indicators among Older Adults in Mexico

“…For example, using an experimental design, Spenkuch (2012) found that people enrolled in SP were less likely to use preventive care. In addition, Molina and Palazuelos (2014), using qualitative interviews, found that people with lower resources were less likely to use SP clinics because they were unable to request medications and the supply chain was weak; hospital inventories were empty and medication never arrived for some patients in this study. Moreover, as it is well known in the econometrics literature, propensity score methods do not fully account for unobservable (unmeasured) confounders.…”

Service, training, mentorship: first report of an innovative education-support program to revitalize primary care social service in Chiapas, Mexico

“…This represents a large work force addressing rural health needs, but there is a growing concern that, similar to interns beginning residency, Mexican pasantes would provide higher quality and safer care if they were supervised, supported, and continued to receive education during the social service year (4, 5). Innovative approaches to supporting and training pasantes during their social service year are sorely needed to help turn Mexico's universal enrollment into true universal effective coverage.…”

“…The remaining 3–4 days are assigned as vacation. This model of concentrating days away from the community purposely differs from the traditional model of pasantes having 1–2 days off a week, because the long trips required to exit and then re-enter isolated rural communities tend to diminish actual time off and promote absenteeism (4, 5). CES-supported clinics also receive supplemental supplies to ensure there are no stock-outs of essential medicines, diagnostic tests, and basic infection control supplies.…”

“…The founders of CES have each worked in the Sierra Madre Mountains of the state of Chiapas – one of the poorest areas in Mexico – for 5–10 years, and found that access to primary care was limited by physician shortages (5). Although Mexico's health system reform in 2003–2004 expanded public health insurance coverage to the poorest Mexicans, its full promise has yet to be realized, as well-trained and logistically supported health care professionals are often not available to provide high-quality care in the rural areas where many of the poorest Mexicans live 7–9) .…”

Ethics in Numbers: Auditing Cleft Treatment in Mexico and Beyond

“…They spoke to me about the “ugly” experiences they had in other clinics and the vulnerability they felt when their children were placed in the care of rude and disrespectful doctors. Such experiences are not isolated to the field of cleft treatment; numerous studies have examined negative patient experiences in Mexican biomedical institutions (Finkler ), especially when they are from low socioeconomic or indigenous backgrounds (Molina and Palazuelos ; Smith‐Oka ).…”