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Waiting Times for Surgical and Diagnostic Procedures in Public Hospitals in Mexico

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Waiting Times for Surgical and Diagnostic Procedures in Public Hospitals in Mexico Waiting times for elective care in Mexico ARTÍCULO ORIGINAL Waiting times for surgical and diagnostic procedures in public hospitals in Mexico David Contreras-Loya, MSc,(1) Octavio Gómez-Dantés, MD, MPH,(1) Esteban Puentes, DVM, MPH,(2) Francisco Garrido-Latorre, MD, PhD,(2) Manuel Castro-Tinoco, BA, MPH,(1) Germán Fajardo-Dolci, MD.(3) Contreras-Loya D, Gómez-Dantés O, Puentes E, Contreras-Loya D, Gómez-Dantés O, Puentes E, Garrido-Latorre F, Castro-Tinoco M, Fajardo-Dolci G. Garrido-Latorre F, Castro-Tinoco M, Fajardo-Dolci G. Waiting times for surgical and diagnostic Tiempos de espera para procedimientos quirúrgicos procedures in public hospitals in Mexico. y diagnósticos en hospitales públicos de México. Salud Publica Mex 2015:57:29-37. Salud Publica Mex 2015:57:29-37. Abstract Resumen Objective. A retrospective evaluation of waiting times for Objetivo. Se llevó a cabo una evaluación retrospectiva de elective procedures was conducted in a sample of Mexican los tiempos de espera para procedimientos electivos en una public hospitals from the following institutions: the Mexican muestra de hospitales públicos en México de las siguientes Institute for Social Security (IMSS), the Institute for Social instituciones: Instituto Mexicano del Seguro Social (IMSS), Security and Social Services for Civil Servants (ISSSTE) and Instituto de Seguridad y Servicios Sociales de los Trabajadores the Ministry of Health (MoH). Our aim was to describe cur- del Estado (ISSSTE) y Secretaría de Salud (SS). El propósito rent waiting times and identify opportunities to redistribute era describir la situación actual en materia de tiempos de service demand among public institutions. Materials and espera e identificar oportunidades de redistribución de la methods. We examined current waiting times and produc- demanda de servicios entre instituciones públicas. Mate- tivity for seven elective surgical and four diagnostic imaging rial y métodos. Se analizaron los tiempos de espera y la procedures, selected on the basis of their relative frequency productividad para siete procedimientos quirúrgicos y cuatro and comparability with other national health systems. Re- procedimientos diagnósticos seleccionados sobre la base de sults. Mean waiting time for the seven surgical procedures su frecuencia relativa y comparabilidad con otros sistemas in the three institutions was 14 weeks. IMSS and ISSSTE de salud nacionales. Resultados. El tiempo de espera pro- hospitals showed better performance (12 and 13 weeks) medio para los siete procedimientos quirúrgicos en las tres than the MoH hospitals (15 weeks). Mean waiting time for instituciones fue de 14 semanas. Los hospitales del IMSS y el the four diagnostic procedures was 11 weeks. IMSS hospitals ISSSTE mostraron un mejor desempeño (12 y 13 semanas) (10 weeks) showed better average waiting times than ISSSTE frente a los hospitales de la SS (15 semanas). El tiempo de (12 weeks) and MoH hospitals (11 weeks). Conclusion. espera promedio para los cuatro procedimientos diagnós- Substantial variations were revealed, not only among institu- ticos fue de 11 semanas. Los hospitales del IMSS mostraron tions but also within the same institution. These variations un tiempo de espera promedio mejor (10 semanas) que los need to be addressed in order to improve patient satisfaction. hospitales del ISSSTE (12 semanas) y la SS (11 semanas). Conclusión. Se identificaron variaciones importantes no sólo entre instituciones sino también al interior de cada una de ellas. Estas variaciones deben atenderse para así mejorar la satisfacción de los usuarios de los servicios. Key words: waiting lists; health system; utilization; consumer Palabras clave: listas de espera; sistema de salud; utilización; satisfaction; quality control satisfacción de los consumidores; control de calidad (1) Instituto Nacional de Salud Pública. Mexico. (2) Secretaría de Salud. Mexico. (3) Instituto Mexicano del Seguro Social. Mexico. Received on: May 29, 2014 • Accepted on: October 30, 2014 Corresponding author: Dr. Octavio Gómez-Dantés. Genovevo de la O 103A. col. Santa María Ahuacatitlán. 62100 Cuernavaca, Morelos, Mexico. E-mail: [email protected] salud pública de méxico / vol. 57, no. 1, enero-febrero de 2015 29 ARTÍCULO ORIGINAL Contreras-Loya D y col. ne of the challenges faced by health systems all through a new public health insurance scheme called around the world is the design of management Seguro Popular.14,15 structuresO that enhance the ability to provide proper Public institutions providing healthcare in México medical care, which is associated to an optimal combi- lack a robust healthcare waiting time measurement nation of scientific knowledge, practical abilities, and system except for IMSS, who has implemented indica- timely, sensitive and respectful care. Some of these at- tors of opportunity of care in hospital and outpatient tributes of healthcare have been aggregated in the term settings.16 However, the quality control of the registers “responsiveness”, one of the three intrinsic objectives is unclear and the level of disaggregation is not compa- of health systems.1 rable with information systems of other countries.17,18 Waiting times for elective procedures lie at the core Consequently, it remains unknown in what degree such of the patient’s experience in the process of receiving times are meeting patients’ needs and public expecta- healthcare. In fact, all health systems have developed tions. Objective information on waiting times could mechanisms to rationally manage the provision of help improve the delivery of healthcare, the health such services. The upward trend in waiting times for conditions of the population, and the public satisfac- elective procedures has created concerns about their tion with the healthcare provided by public facilities. negative effects on patient’s conditions and satisfac- The main objective of the project that nourished this tion levels.2 However, the question about the degree to paper was to measure the waiting times for a group of which long waiting times to receive elective healthcare 11 clinical tracers, including surgeries and diagnostic negatively affect health outcomes remains, in general, procedures, in a sample of hospitals of the three main unanswered. In fact, there is little evidence showing public providers of health services in Mexico and as- that long waiting times can lead to the deterioration sess variation in waiting times among institutions. An of health.3 There are, however, some exceptions. Long additional objective of this study was to identify gaps waiting times to receive surgical care for severe trauma in public hospital performance that could be addressed among the elderly or in the presence of comorbidities through service exchange mechanisms among IMSS, are associated to an increased mortality risk.4-6 Long ISSSTE and MoH. waiting times also affect the health of patients in poor physical conditions or those awaiting elective poste- Materials and methods rior lumbar spinal surgery, humeral fracture repair in pediatric patients or coronary artery bypass graft A cross-sectional study was carried-out in a sample of surgery.7-9 Long waiting times in the last two groups of 51 hospitals selected by convenience. The hospitals were patients were associated with prolonged use of hospital selected based on their location. The sample frame in- services in general, blood products and intensive care cluded only general hospitals located in urban areas and units.10 Meta-analyses carried out to assess the effect belonging to the three main public health institutions. of long waiting times to receive a number of interven- Cities with current reports of violence were excluded. tions, found that comorbidities are independently and The sample frame included 158 hospitals located in 54 positively associated with delayed access to cholecys- municipalities and 37 urban areas. Eleven clinical tracers tectomy and breast cancer surgery, but also with the (seven surgical and four diagnostic procedures) were incidence of post-procedure complications.11 In Mexico, selected based on their relative frequency: cholecys- evidence indicates that long waiting times for elective tectomy, hernia repair, hysterectomy, hip replacement, procedures in public hospitals are an important cause cataract surgery, amygdalectomy/adenoidectomy, of patient dissatisfaction.12 prostatectomy, computerized axial tomography (CAT), The Mexican health system comprises two basic diagnostic ultrasound, endoscopy (gastroscopy and components, the public and the private sector.13 The colonoscopy), and mammography. public sector, in turn, includes two basic sets of institu- tions: the social security institutions, most prominently 1. Waiting times analysis the Mexican Institute for Social Security (IMSS) and the Institute for Social Security and Social Services for Civil Data on waiting times was collected using as source of Servants (ISSSTE), which provide care to the workers information the clinical record of the last 30 patients of the formal sector of the economy and their families, at each facility receiving those procedures in 2011. and the institutions providing care for the non-salaried Some hospitals did not reach the selected number population, most notably the Ministry of Health (MoH) of procedures for all tracers due to low demand for 30 salud pública de méxico / vol. 57, no. 1, enero-febrero de 2015 Waiting times for elective care in Mexico ARTÍCULO ORIGINAL those services or the existence of medical records ment, operating
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