ArticleHealth research policy and systems2020
Bridging the gap: an economic case study of the impact and cost effectiveness of comprehensive healthcare intermediaries in rural Mexico.
Article in Health research policy and systems, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Contextual challenges and impacts on the surgical ecosystem in Chiapas, Mexico: A qualitative study.PloS one · 2025Article
- Collaborations and Networks Within Communities for Improved Utilization of Primary Healthcare Centers: On the Road to Universal Health Coverage.International journal of public health · 2024Article
- Rethinking referral systems in rural chiapas: A mixed methods study.Dialogues in health · 2023Article
- Immediate identification and management of an open posterior knee dislocation: Important lessons from a case report.Trauma case reports · 2023Article
- Integrating multi-national teams: over a decade of lessons learned in Chiapas with Partners in Health-Mexico.Frontiers in public health · 2023Article
- Interpersonal challenges in surgical care provision in rural Mexico: A qualitative study.Lancet regional health. Americas · 2022Article
- Impact of a Novel Social Work Program on Access to Tertiary Care.Annals of global health · 2022Article
- Article
- Understanding Community Participation in Rural Health Care: A Participatory Learning and Action Approach.Frontiers in public health · 2022Article
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Authors and funding
5 authors.
Funding
Abstract
backgroundIn rural settings where patients face significant structural barriers to accessing healthcare services, the formal existence of government-provided health coverage does not necessarily translate to meaningful care delivery. This paper analyses the effectiveness of an innovative approach to overcome these barriers, the Right to Health Care programme offered by Compañeros en Salud in Chiapas, Mexico. This programme provides comprehensive free coverage of all additional direct and indirect medical costs as well as accompaniment through the medical system. Over 550 patients had participated from 2013 until November 2018.
methodsFocusing on ten of the most frequently treated conditions, including hernias, cataracts and congenital heart defects, we performed a retrospective case study analysis of the quality-adjusted life years (QALYs) gained from treatment and the cost per QALY for 69 patients. This analysis used disability weights and uncertainty intervals from the Global Burden of Disease study and organisational micro-costing data for each patient. Each patient was compared to their own hypothetical counterfactual health outcome had they not received the secondary and tertiary care required for the specific condition. A mixed methods approach is used to establish this counterfactual baseline, drawing on pre-intervention observations, qualitative interviews and established literature precedent.
resultsThe programme was found to deliver an average of 14.4 additional QALYs (95% uncertainty interval 12.4-15.8) without time discounting. The mean cost per QALY over these conditions was $388 USD (95% UI $262-588) at purchasing power parity.
conclusionsThese numbers compare favourably with studies of other health services and international cost per QALY guidelines. They reflect the on-treatment effect for the ten conditions analysed and are presented as a case study indicative of the promise of healthcare intermediaries rather than a definitive assessment of cost-effectiveness. Nonetheless, these results show the potential feasibility and cost effectiveness of a more comprehensive approach to healthcare provision in a resource-limited rural setting.
trial registrationThis study involves economic analysis of a programme facilitating access to public healthcare services. Thus, there was no associated clinical trial to be registered.
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