title: Scaling up cancer care for children without medical insurance in developing countries: The case of Mexico.
abstract: BACKGROUND
  In 2006, the Mexican government launched the Fund for Protection Against Catastrophic Expenditures (FPGC) to support financially healthcare of high cost illnesses. This study aimed at answering the question whether FPGC improved coverage for cancer care and to measure survival of FPGC affiliated children with cancer.
  
  
  METHODS
  A retrospective cohort study (2006-2009) was conducted in 47 public hospitals. Information of children and adolescents with cancer was analyzed. The coverage was estimated in accordance with expected number of incident cases and those registered at FPGC. The survival was analyzed by using Kaplan-Meier survival curves and Cox proportional hazards regression modeling.
  
  
  RESULTS
  The study included 3,821 patients. From 2006 to 2009, coverage of new cancer cases increased from 3.3% to 55.3%. Principal diagnoses were acute lymphoblastic leukemia (ALL, 46.4%), central nervous system (CNS) tumors (8.2%), and acute myeloid leukemia (AML, 7.4%). The survival rates at 36 months were ALL (50%), AML (30.5%), Hodgkin lymphoma (74.5%), Non-Hodgkin lymphoma (40.1%), CNS tumors (32.8%), renal tumors (58.4%), bone tumors (33.4%), retinoblastoma (59.2%), and other solid tumors (52.6%). The 3-year overall survival rates varied among the regions; children between the east and south-southeast had the higher risks (hazard ratio 3.0; 95% CI: 2.3-3.9) and 2.4; 95% CI: 2.0-2.8) of death from disease when compared with those from the central region.
  
  
  CONCLUSIONS
  FPGC has increased coverage of cancer cases. Survival rates were different throughout the country. It is necessary to evaluate the effectiveness of this policy to increase access and identify opportunities to reduce the differences in survival.
authors.affiliation: Division of Social Protection and Health, Inter American Development Bank, Mexico City, Mexico. rperez@iadb.org
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pérez-Cuevas
authors.forename: Svetlana V
authors.initials: SV
authors.lastname: Doubova
authors.forename: Marta
authors.initials: M
authors.lastname: Zapata-Tarres
authors.forename: Sergio
authors.initials: S
authors.lastname: Flores-Hernández
authors.forename: Lindsay
authors.initials: L
authors.lastname: Frazier
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodríguez-Galindo
authors.forename: Gabriel
authors.initials: G
authors.lastname: Cortes-Gallo
authors.forename: Salomon
authors.initials: S
authors.lastname: Chertorivski-Woldenberg
authors.forename: Onofre
authors.initials: O
authors.lastname: Muñoz-Hernández
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003906:Developing Countries / Q000191:economics; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D008483:Medical Assistance; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008800:Mexico / Q000453:epidemiology; D009369:Neoplasms / Q000191:economics* / Q000401:mortality; D012189:Retrospective Studies