Users' perception of quality as a driver of private healthcare use in Mexico: Insights from the People's Voice Survey

Authors

Svetlana V. Doubova, Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico.
Hannah H. Leslie, Division of Prevention Science, University of California San Francisco, San Francisco, California, United States of America.
Ricardo Pérez-Cuevas, Division of Social Protection and Health, Interamerican Development Bank, Washington, DC, United States of America.
Margaret E. Kruk, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.
Catherine Arsenault, Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America.

Document Type

Journal Article

Publication Date

1-1-2024

Journal

PloS one

Volume

19

Issue

6

DOI

10.1371/journal.pone.0306179

Abstract

OBJECTIVE: The Mexican government has pursued multiple initiatives to improve healthcare coverage and financial protection. Yet, out-of-pocket health spending and use of private sector providers in Mexico remains high. In this paper, we sought to describe the characteristics of public and private healthcare users, describe recent visit quality across provider types, and to assess whether perceiving the public healthcare sector as poor quality is associated with private health sector use. METHODS AND FINDINGS: We analyzed the cross-sectional People's Voice Survey conducted from December 2022 to January 2023. We used Chi-square tests to compare contextual, individual, and need-for-care factors and ratings of most recent visits between users of public (social security and other public providers) and private sector providers (stand-alone private providers and providers adjacent to pharmacies). We used a multivariable Poisson regression model to assess associations between low ratings of public healthcare sources and the use of private care. Among the 811 respondents with a healthcare visit in the past year, 31.2% used private sources. Private healthcare users were more educated and had higher incomes than public healthcare users. Quality of most recent visit was rated more highly in private providers (70.2% rating the visit as excellent or very good for stand-alone private providers and 54.3% for pharmacy-adjacent doctors) compared to social security (41.6%) and other public providers (46.6%). Those who perceived public health institutions as low quality had a higher probability of seeking private healthcare. CONCLUSION: Users rated public care visits poorly relative to private care; at the population level, perceptions of poor quality care may drive private care use and hence out-of-pocket costs. Improving public healthcare quality is necessary to ensure universal health coverage.

APA Citation

Doubova, Svetlana V.; Leslie, Hannah H.; Pérez-Cuevas, Ricardo; Kruk, Margaret E.; and Arsenault, Catherine, "Users' perception of quality as a driver of private healthcare use in Mexico: Insights from the People's Voice Survey" (2024). GW Authored Works. Paper 5053.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5053

Department

Global Health