Analysis of the effectiveness of primary care services and of hospital efficiency in the Mexican health care system

In 2003, Mexico conducted a major health reform that transformed its health system to gradually extend health care insurance coverage to more than 50 million uninsured. The expansion of insurance coverage increased the demand for health care and the amount of resources allocated to health. However, little is known about the efficiency with which these resources have been used and about the quality of the services provided. This thesis contributes to this literature by analysing the extent to which primary and hospital care providers are making an efficient use of the resources in the system. The first part of the thesis uses ambulatory care sensitive hospitalisations (ACSHs) to analyse the effectiveness of primary care services within and between the 32 states of Mexico during 2001-2011. Additionally, the burden of ACSHs is defined and a methodology to estimate it proposed. The second part of the thesis details the incentive structure faced by Mexican public hospitals and predicts that hospitals will adjust their performance level to meet their external demand. The model is tested by extending previous work that estimates hospital effects on the length of stay of its patients purged of patient and treatment characteristics. Each hospital effect is interpreted as a measure of performance and then used to construct a panel to examine whether variation across hospitals and over time is related to hospital and state characteristics in estimated dependent variable models for 2005-2013. The findings suggest a high heterogeneity in both primary and hospital care performance with well identified groups of best and worst performers. The empirical model on hospital performance supports the theoretical prediction and additionally found that hospital performance is persistent over time and consistent across type of care.