title: Comparing federal and state healthcare provider performance in villages targeted by the conditional cash transfer programme of Mexico.
abstract: OBJECTIVE
  This study investigates household out-of-pocket healthcare expenditures (OPH) and preventive care utilization (PHU) to compare federal and state healthcare provider performance in villages targeted by conditional cash transfer (CCT) programmes in poor rural areas of Mexico.
  
  
  METHODS
  Lower OPH and higher PHU are indicative of better performance in the study setting. Log-linear and probit regression models were used to compare outcomes in households from treatment and control villages reached by federal and state healthcare providers. In treatment villages, eligible households receive cash grants from the CCT programme. In control villages, eligible households do not receive cash grants from the CCT programme at the time of the survey.
  
  
  RESULTS
  Families who live in treatment villages reported lower OPH (-52.5% for federal and -46.2% for state clinics) and higher PHU (21% for federal and 20% for state clinics) regardless of clinic setting. As the reduction in OPH is higher in areas reached by the federal clinics, it implies better performance from this healthcare delivery system. Additionally, federal clinic outcomes were also more homogeneous because OPH are not significantly different between treatment and control villages. Alternative measures such as drug and physician expenditures, diabetes and hypertension tests and nutritional-supplement receipt confirmed these findings.
  
  
  CONCLUSIONS
  Mexico has two healthcare delivery systems that cater to identical rural populations. The better-funded and more centralized federal system is more effective at providing health care in poor rural villages of Mexico regardless of CCT participation. State clinics in villages targeted by the CCT programme, however, perform significantly better.
authors.affiliation: Department of Health Services, Universiy of California, Los Angeles, CA, USA. avb@ucla.edu
authors.forename: Arturo Vargas
authors.initials: AV
authors.lastname: Bustamante
mesh_terms: D000328:Adult; D035082:Federal Government; D005260:Female; D019538:Health Care Surveys; D005102:Health Expenditures; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D016014:Linear Models; D008297:Male; D008800:Mexico; D008875:Middle Aged; D011203:Poverty; D011314:Preventive Health Services / Q000191:economics / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012424:Rural Population / Q000706:statistics & numerical data*; D013219:State Government; D013647:Task Performance and Analysis