Research

Impact of insurance and supply of health professionals on coverage of treatment for hypertension in Mexico: population based study

BMJ 2007; 335 doi: 10.1136/bmj.39350.617616.BE (Published 25 October 2007)
Cite this as: BMJ 2007;335:875
  1. Sara N Bleich, assistant professor1,
  2. David M Cutler, dean of social sciences2,
  3. Alyce S Adams, assistant professor3,
  4. Rafael Lozano, director general of information4,
  5. Christopher J L Murray, director5
  1. 1Johns Hopkins School of Public Health, Baltimore, MD 21205, USA
  2. 2Harvard University Faculty of Arts and Sciences, Cambridge, MA
  3. 3Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA
  4. 4Secretaría de Salud, Mexico DF, Mexico
  5. 5Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA
  1. Correspondence to: S N Bleich sbleich@jhsph.edu
  • Accepted 18 September 2007

Abstract

Objective To examine the independent and combined contributions of insurance status and supply of health professionals on coverage of antihypertensive treatment among adults in Mexico.

Design Population based study.

Setting Mexico.

Participants 4032 hypertensive adults (2967 uninsured and 1065 insured): 1065 uninsured adults matched with 1065 adults insured through Seguro Popular, a programme to expand health insurance coverage to uninsured people in Mexico.

Main outcome measures Coverage of antihypertensive treatment and coverage of antihypertensive treatment with control of blood pressure.

Results Rates of treatment for hypertension varied by insurance status and supply of health professionals. Hypertensive adults insured through Seguro Popular had a significantly higher probability of receiving antihypertensive treatment (odds ratio 1.50, 95% confidence interval 1.27 to 1.78) and receiving antihypertensive treatment with control of blood pressure (1.35, 1.00 to 1.82). Greater supply of health professionals in areas with coverage through Seguro Popular was a significant predictor of antihypertensive treatment after adjusting for covariates (1.49, 1.00 to 2.20).

Conclusions Expansion of healthcare coverage to uninsured people in Mexico was associated with greater use of antihypertensive treatment and blood pressure control, particularly in areas with a greater supply of health professionals.

Footnotes

  • We thank Michael Law, Emmanuela Gakidou, Goodarz Danaei, Gretchen Stevens, and Majid Ezzati for help with the analysis, and the Secretaría de Salud, who created the datasets used in this study.

  • Contributors: SNB, DMC, AA, and CJLM conceived the study and developed the hypotheses. SNB analysed the data. All authors contributed to the interpretation of study findings. SNB drafted the manuscript and all authors contributed to the final draft. SNB is the guarantor.

  • Funding: Harvard Graduate School of Arts and Sciences dissertation completion fellowship.

  • Competing interests: None declared

  • Ethical approval: Not required.

  • Accepted 18 September 2007

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