Health services analysis as a tool for evidence-based policy decisions: the case of the Ministry of Health and Social Security in Mexico.
OBJECTIVE
To describe the strengths and weaknesses of two Mexican health care providers for poor populations [Ministry of Health (MoH) and Social Security (SS)] in order to facilitate policy decisions about the future of the two systems.


METHODS
In four Mexican states we conducted (i) a household interview survey in 10 724 households; (ii) a user satisfaction survey in 1319 households; (iii) a satisfaction survey of 236 health workers; (iv) in-depth interviews with 190 health workers; (v) 188 focus-group discussions with different population groups; (vi) a document analysis.


RESULTS
Both systems serve populations with similar characteristics of poverty. The availability of resources was better in the MoH system; SS care was better concerning process indicators (family planning, antenatal care; in-service delivery of drugs, staff productivity, user satisfaction and staff motivation), efficiency and effectiveness (reduction of morbidity and mortality). Possible explanatory factors for the better performance of the SS system were strong supervision, regular communication, joint data analysis and annual population surveys.


CONCLUSIONS
Better service organization makes a difference regarding efficiency and effectiveness. Policy-makers, deciding on which kind of health services are best for the poor, should take into account health services' analyses.
Kroeger
Axel
A
Liverpool School of Tropical Medicine, Liverpool, UK. kroegera@who.int
Hernandez
Juan Manuel
JM
D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003659:Decision Making, Organizational; D019317:Evidence-Based Medicine / Q000379:methods*; D017144:Focus Groups; D019538:Health Care Surveys; D006291:Health Policy; D006295:Health Resources / Q000600:supply & distribution; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D008800:Mexico; D010043:Outcome and Process Assessment, Health Care; D011050:Policy Making; D011203:Poverty; D011635:Public Health Administration / Q000592:standards*; D012943:Social Security / Q000592:standards*