The treatment received by public health services users in Mexico

Objective. To document the fact that differences in the treatment received by health services users in Mexico are mainly dependent on the type of provider, regardless of the users' socioeconomic status. Methods. The data were obtained by means of a survey of 18 018 users who visited 73 health services in 13 states within Mexico. They were asked to grade the way the institution had performed in seven of the eight domains that define appropriate user treatment (autonomy, confidentiality, communication, respectful manner, condition of basic facilities, access to social assistance networks, and free user choice). The questionnaire included some vignettes to help determine user expectations. A composite ordinal probit model was applied; the perception of quality in connection with each of the appropriate treatment domains was the independent variable, whereas gender, educational level, age, type of provider, and user expectations were used as control variables. Results. The type of provider was the main factor that determined users' perceptions regarding the treatment they received when visiting health services in Mexico. Institutions belonging to the social security system performed the worst, while the services provided under the program targeting the rural population (IMSS Oportunidades) received the highest scores. Overall, the domain that was most highly ranked was respectful manner, whereas the lowest score was given to the ability to choose the provider. Men felt they had been able to communicate better than women, while respectful manner, communication, and social support showed a significant negative association with educational level (P < 0.05). Conclusions. Differences were noted in the way different public health service providers in Mexico treat their users, regardless of the latter's socioeconomic status. Social security system providers showed the greatest deficiencies in this respect. Respectful manner was the domain that received the highest scores in the case of all providers. Organizational changes need to be made, since the shortcomings detected are not solely determined by factors related to health personnel, but also by certain aspects of the way the health system is structured in Mexico.