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Rethinking referral systems in rural chiapas: A mixed methods study.

Valeria Macias1, Zulema Garcia1, William Pavlis2

  • 1Compañeros en Salud, Ángel Albino Corzo, Mexico.

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|March 22, 2024
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Summary
This summary is machine-generated.

Access to surgery in Chiapas is limited by an inefficient referral system. Only 47.4% of referred patients received surgery, highlighting significant barriers to universal health coverage.

Keywords:
ChiapasGlobal surgeryMexicoReferral systemSurgery

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Area of Science:

  • Public Health
  • Health Services Research
  • Surgical Outcomes

Background:

  • Significant disparities in surgical access persist in Chiapas, Mexico, despite universal health coverage initiatives.
  • The effectiveness of the surgical referral system within Ministry of Health hospitals in Chiapas has not been thoroughly evaluated.

Purpose of the Study:

  • To determine the effectiveness of the surgical referral system in public hospitals in Chiapas.
  • To identify barriers and facilitators to accessing surgical care within the public health system.

Main Methods:

  • A convergent mixed-methods approach was employed, analyzing quantitative referral data and qualitative interviews.
  • Data were collected from three public hospitals in Chiapas over three years, including health care workers and surgical patients.
  • 13 variables were extracted from referral data; interviews explored patient and provider experiences.

Main Results:

  • Only 47.4% of referred patients requiring surgery ultimately received an operation.
  • Factors associated with lower surgery rates included elective procedures, gynecological/orthopedic specialties, and surgery cancellations.
  • Key themes identified were gender, specialty, economic fragility, cost barriers, pain as a motivator, and perceived futility leading to system abandonment.

Conclusions:

  • The surgical referral system in Chiapas is inefficient and costly, causing delays and driving patients to the private sector.
  • Findings reveal critical limitations to universal health coverage, necessitating improvements in system coordination, hospital resources, and protocols.
  • Addressing these systemic issues is crucial to ensure equitable access to guaranteed surgical care.