Health system reform in Mexico 3 - Benchmarking of performance of Mexican states with effective coverage
Health system reform in Mexico 3 - Benchmarking of performance of Mexican states with effective coverage
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DOI：
10.1016/s0140-6736(06)69566-4
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发表时间：
2006-11-11
期刊：
影响因子：
168.9
通讯作者：
Murray, Christopher J. L.
中科院分区：
文献类型：
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作者：
Lozano, Rafael;Soliz, Patricia;Murray, Christopher J. L.
在一个分散的卫生系统中，对各州、省或区的绩效进行基准比较，对于促进问责、监测进展、确定成败的决定因素以及创建证据文化非常重要。自2001年以来，墨西哥卫生部采用了以世卫组织干预有效覆盖面概念为基础的基准方法，其定义是卫生系统可提供的潜在健康收益与实际提供的健康收益的比例。利用数据收集系统，包括州代表检查调查、生命登记和医院出院登记，我们监测了2005-06年间14项干预措施的交付情况。总体有效覆盖率从贫困州恰帕斯州的54.0%到联邦区的65.1%不等。孕产妇和儿童健康干预措施的有效覆盖率大大高于针对其他健康问题的干预措施。最低财富五分之一的有效覆盖率为52%，而最高五分之一的有效覆盖率为61%。有效覆盖率与各州的人均公共卫生支出密切相关；与孕产妇和儿童健康无关的干预措施的这种关系比与孕产妇和儿童健康无关的干预措施更强。在支出数额相近的情况下，有效覆盖面也存在相当大的差异。我们讨论了这些问题对墨西哥卫生信息系统进一步发展的影响。通过衡量有效覆盖率来确定绩效基准鼓励决策者把重点放在高质量的服务提供上，而不仅仅是服务的可用性。有效覆盖率计算是卫生系统管理的重要手段。在采用这一办法时，其他国家应根据可负担性、对人口健康的影响、对健康不平等的影响以及衡量干预效果的能力等标准来选择要衡量的干预措施。承担这一基准的国家机构必须拥有成功的授权、技能、资源和独立性。
Benchmarking of the performance of states, provinces, or districts in a decentralised health system is important for fostering of accountability, monitoring of progress, identification of determinants of success and failure, and creation of a culture of evidence. The Mexican Ministry of Health has, since 2001, used a benchmarking approach based on the WHO concept of effective coverage of an intervention, which is defined as the proportion of potential health gain that could be delivered by the health system to that which is actually delivered. Using data collection systems, including state representative examination surveys, vital registration, and hospital discharge registries, we have monitored the delivery of 14 interventions for 2005-06. Overall effective coverage ranges from 54.0% in Chiapas, a poor state, to 65.1% in the Federal District. Effective coverage for maternal and child health interventions is substantially higher than that for interventions that target other health problems. Effective coverage for the lowest wealth quintile is 52% compared with 61% for the highest quintile. Effective coverage is closely related to public-health spending per head across states; this relation is stronger for interventions that are not related to maternal and child health than those for maternal and child health. Considerable variation also exists in effective coverage at similar amounts of spending. We discuss the implications of these issues for the further development of the Mexican health-information system. Benchmarking of performance by measuring effective coverage encourages decision-makers to focus on quality service provision, not only service availability. The effective coverage calculation is an important device for health-system stewardship. in adopting this approach, other countries should select interventions to be measured on the basis of the criteria of affordability, effect on population health, effect on health inequalities, and capacity to measure the effects of the intervention. The national institutions undertaking this benchmarking must have the mandate, skills, resources, and independence to succeed.