title: [Health expenditures, income inequality, and the marginalization index in Mexico's health system].
abstract: OBJECTIVE
  Evaluate the effect of the relationship among public health expenditures, income inequality, and the marginalization index on maternal and child mortality in Mexico, to determine the effect of these factors on health system performance from a technical efficiency perspective.
  
  
  METHODS
  An ecological study of 32 Mexican states. Correlations were estimated between maternal and infant mortality and public health expenditures in total per capita, federal per capita, and state per capita for the years 2000, 2005, and 2010 (Gini coefficient and marginalization index). Linear regressions were used to explore the association of these variables with health indicators in the state systems.
  
  
  RESULTS
  Negative correlations were observed for the marginalization index and Gini coefficient with regard to life expectancy at birth (-0.62 and -0.28 respectively). Furthermore, there was a positive correlation of 0.59 between the marginalization index and infant mortality (P <0.05). Multiple linear regression models revealed a negative effect of the marginalization index and Gini coefficient on health out-comes. Federal funding had a positive effect on system performance in terms of health indicators.
  
  
  CONCLUSIONS
  Health system reform in Mexico has had a positive impact on the country's health indicators; federal financial investment seems to be effective in this regard. Social determinants have an important effect on health system performance, and analysis using multisectoral and multidisciplinary approaches are needed in addressing them.
authors.affiliation: Instituto Nacional de Salud Pública, Cuernavaca, México, cepinzon@gmail.com.
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Pinzón Florez
authors.affiliation: Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Reveiz
authors.affiliation: Departamento de Salud Pública, Escuela de Medicina, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia.
authors.forename: Alvaro J
authors.initials: AJ
authors.lastname: Idrovo
authors.affiliation: Instituto Nacional de Salud Pública, Cuernavaca, México, cepinzon@gmail.com.
authors.forename: Hortensia
authors.initials: H
authors.lastname: Reyes Morales
mesh_terms: D003695:Delivery of Health Care / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D008297:Male; D008800:Mexico; D011634:Public Health; D012959:Socioeconomic Factors