Loss of job-related right to healthcare associated with employment turnover: challenges for the Mexican health system
The Mexican health system segments access and right to healthcare according to worker position in the labour market. In this contribution we analyse how access and continuity of healthcare gets interrupted by employment turnover in the labour market, including its formal and informal sectors, as exp...
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2018 |
| País: | México |
| Institución: | Instituto Nacional de Salud Pública |
| Repositorio: | Repositorio Institucional Abierto de Conocimiento en Salud Pública |
| Idioma: | español |
| OAI Identifier: | oai:repositorio.insp.mx:20.500.12096/7805 |
| Acceso en línea: | https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3283-7 https://www.doi.org/10.1186/s12913-018-3283-7 http://repositorio.insp.mx:8080/jspui/handle/20.500.12096/7805 |
| Access Level: | acceso abierto |
| Palabra clave: | AdolescentAdultContinuity of Patient Care statistics numerical data,Diabetes Mellitus, Type 2 therapy,FemaleHealth Services Accessibility statistics numerical dataHealth Services ResearchHumansInsurance, Health statistics numerical dataMaleMexicoMiddle AgedNeeds AssessmentPersonnel TurnoverPrimary Health Care statistics numerical dataQuality of Health Care standardsSocial SecurityUnemployment statistics numerical dataYoung Adult,Chronic illness, Healthcare utilization Informal sector Labour markets. info:eu-repo/classification/cti/3 |
| Sumario: | The Mexican health system segments access and right to healthcare according to worker position in the labour market. In this contribution we analyse how access and continuity of healthcare gets interrupted by employment turnover in the labour market, including its formal and informal sectors, as experienced by affiliates to the Mexican Institute of Social Security (IMSS) at national level, and of workers with type 2 diabetes (T2DM) in Mexico City. Methods: Using data from the National Employment and Occupation Survey, 2014, and from IMSS electronic medical records for workers in Mexico City, we estimated annual employment turnover rates to measure the loss of healthcare access due to labour market dynamics. We fitted a binary logistic regression model to analyse the association between sociodemographic variables and employment turnover. Lastly we analysed job-related access to health care in relation to employment turnover events. Results: At national level, 38.3% of IMSS affiliates experienced employment turnover at least once, thus losing the right to access to healthcare. The turnover rate for T2DM patients was 22.5%. Employment turnover was more frequent at ages 20-39 (38.6% national level; 28% T2DM) and among the elderly (62.4% national level; 26% T2DM). At the national level, higher educational levels (upper-middle, OR = 0.761; upper, OR = 0.835) and income (5 minimum wages or more, OR = 0.726) were associated with lower turnover. Being single and younger were associated with higher turnover (OR = 1.413). T2DM patients aged 40-59 (OR = 0.655) and with 5 minimum wages or more (OR = 0.401) experienced less turnover. Being a T2DM male patient increased the risk of experiencing turnover (OR = 1.166). Up to 89% of workers losing IMSS affiliation and moving on to other jobs failed to gain job-related access to health services. Only 9% gained access to the federal workers social security institute (ISSSTE). Conclusions: Turnover across labour market sectors is frequently experienced by the workforce in Mexico, worsening among the elderly and the young, and affecting patients with chronic diseases. This situation needs to be prospectively addressed by health system policies that aim to expand the financial health protection during an employment turnover event. |
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