Innovation in reducing out-of pocket cost for health care and TB-related cost coverage. Country perspective1 Detener la tuberculosis es compromiso de todos
Tuberculosis in Mexico, 2012 21,426 registers of TB all forms (prevalence) 19,735 TB new cases 80.7% pulmonary 1.5% meningea 5.9% nodal 129 with DR 18.5% with diabetes 5.6% TB/Aids 11% in pediatrics (<19años) *2,531 TB deaths 11.9% other forms Fuente: Plataforma Única de Información/SUIVE/DGE/SS 2012-25/02/2013, *DGIS/CUBOS 2011 Tx Éxito successful terapéutico
TB-HIV/Aids, incidence Mexico, 2003, 2007, 2012 Estate Cases % rate AGUASCALIENTES 9 11.3 0.7 BAJA CALIFORNIA 139 6.5 4.2 BAJA CALIFORNIA SUR 10 5.9 1.4 CAMPECHE 9 6.2 1.0 COAHUILA 15 2.4 0.5 COLIMA 14 8.6 2.0 CHIAPAS 45 3.4 0.9 CHIHUAHUA 28 3.5 0.8 DISTRITO FEDERAL 105 12.7 1.2 DURANGO 14 5.7 0.8 GUANAJUATO 17 4.7 0.3 GUERRERO 65 4.9 1.9 HIDALGO 10 3.4 0.4 JALISCO 105 9.2 1.4 MEXICO 56 6.2 0.3 MICHOACAN 15 4.4 0.3 MORELOS 11 6.1 0.6 NAYARIT 15 5.1 1.3 NUEVO LEON 97 6.9 2.0 OAXACA 23 2.8 0.6 PUEBLA 25 4.5 0.4 QUERETARO 10 4.2 0.5 QUINTANA ROO 42 12.8 2.9 SAN LUIS POTOSI 16 4.0 0.6 SINALOA 31 3.2 1.1 SONORA 43 4.5 1.5 TABASCO 30 5.1 1.3 TAMAULIPAS 66 5.2 1.9 TLAXCALA 1 2.0 0.1 VERACRUZ 112 5.2 1.4 YUCATAN 19 7.5 0.9 ZACATECAS 4 5.1 0.3 TOTAL 1,201 5.6 1.0 Mexico 2003 n= 598 Cases >30 y more 15 29 < de 15 9.3% Mexico 2012 n= 1,201 Fuente: Plataforma Única de Información/SUIVE/DGE/SS. 2012 25/02/2013 Mexico 2007 n= 652 84% 101% increase from 2003 to 2012
TB-Diabetes Mellitus prevalence Mexico, 2003-2007-2012 Estate Cases % rate AGUASCALIENTES 8 16.3 0.6 BAJA CALIFORNIA 213 9.7 6.4 BAJA CALIFORNIA SUR 23 17.7 3.3 CAMPECHE 29 25.4 3.3 COAHUILA 126 34.0 4.4 COLIMA 28 22.4 4.1 CHIAPAS 232 21.8 4.6 CHIHUAHUA 122 15.4 3.4 DISTRITO FEDERAL 160 22.0 1.8 DURANGO 47 22.6 2.8 GUANAJUATO 87 24.2 1.5 GUERRERO 311 30.6 8.9 HIDALGO 51 15.8 1.8 JALISCO 169 18.5 2.2 MEXICO 202 28.1 1.3 MICHOACAN 66 23.0 1.5 MORELOS 47 33.1 2.5 NAYARIT 37 25.0 3.2 NUEVO LEON 347 23.5 7.1 OAXACA 142 34.3 3.6 PUEBLA 150 30.0 2.5 QUERETARO 51 23.5 2.7 QUINTANA ROO 56 18.9 3.9 SAN LUIS POTOSI 83 20.9 3.1 SINALOA 104 14.3 3.6 SONORA 117 10.2 4.2 TABASCO 128 30.0 5.5 TAMAULIPAS 316 28.9 9.2 TLAXCALA 14 48.3 1.1 VERACRUZ 492 22.8 6.3 YUCATAN 45 21.2 2.2 ZACATECAS 21 38.9 1.4 NATIONAL 4024 21.4 3.4 Mexico 2003 N= 1,469 Casos >50 y mas 13 49 < de 12 113% Mexico 2007 N= 3,130 Mexico 2012 N= 4,024 28.6% 174% increase from 2003 to 2012 *Fuente: Plataforma Única de Información/SUIVE/DGE/SS. Preliminar 2012 25/02/2013
TB-DR Mexico Cases notified with TB DR, Mexico 2000-2012 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 30 29 128 129 114 95 82 73 51 Núm de Casos Fuente: PNT / MACRO TB MFR * Al 28 /02/2013 156 % de negativization to 6 months of traatment: MDR= 79% XDR= 66% 185 206 217 15 Estates concentrate 85% of total national 629 cases enrolled with second line drugs 2010-2012 TAMAULIPAS 71 VERACRUZ 62 BAJA CALIF 60 NUEVO LEÓN 50 CHIAPAS 46 GUERRERO 43 PUEBLA 43 CHIHUAHUA 25 COAHUILA 23 OAXACA 21 SINALOA 17 SONORA 17 HIDALGO 14 MORELOS 10 BAJA CALIF SUR 5 COLIMA 4 DISTRITO FEDERAL 17 MÉXICO 29 GUANAJUATO 12 JALISCO 10 TABASCO 9 MICHOACÁN 8 YUCATAN 7 QUINTANA ROO 4 DURANGO 3 QUERÉTARO 3 ZACATECAS 2 CAMPECHE 1 NAYARIT 1 SAN LUIS POTOSÍ 6 AGUASCALIENTES 3 TLAXCALA 3 NATIONAL 2010-12 629
Current situation Heterogeneous Health System MoH: 56% Regular atention Popular health care (SEGURO POPULAR) Population coverage: Social Security (IMSS): 40% ISSSTE 3% Private 1% TB Prevalence: MoH: 70% IMSS: 27% ISSSTE: 2% Private: 1%
52 millions 871 thousand 916 coverage till october 2012
The facts: SPPS/Seguro Popular 100% coverage capacity for TB prevalence (healt care) Diagnosis and treatment of: TB sensitive TB MDR Majority % in poverty: (with out job) Needs af alimentary dispenses (food) Needs to go to HC to take DOT With some comorbidities: DM: 1 of each 5: 21% and 47.8 50% of TB-MDR with DM Malnutrition: 10% AIDS: 6% (All Forms) Alcohol and Drugs abuse 5% 2.7 4.1 6.0 4.8 21.0 1.1 0.1 10.3 0.3 0.9 0.4 0.1 0.2 0.2 VIH/SIDA ALCOHOLISMO DIABETE S DESNUTR ICION CIRROSIS NEOPLASIS INSUFICIENCIA CARDIACA EPOC EDEMA AGUDO PULMONAR EMBARAZO
TB Social Protection System in Mexico (SEGURO POPULAR) Estrategies: 1.Deliver free essential of health services (full coverage for Dx and Tx) 2.Education for self-care in health; 3.Promotion of a better nutrition 4.Reinforcement to offer: 266 interventions for free access, among of them is the prevention and tuberculosis control including MDR. The epidemiological surveillance of TB is in a better coverage levels of SEGURO POPULAR to detect in time other needs of TB patients in order to implement an integral (holistic care).
More facts: Seguro Popular: CAUSES: Catalogo Universal de Servicios de Salud: 266 interventions: Num.106: Dx and Tx of TB Num. 107: Dx and Tx of TB-MDR BCG TB Chemioprophilaxis (H) Diagnosis and treatment of : Malnutrition Diabetes HIV-Aids
Perspective: URGENT: To impeach the over counter selling of TB medication in the private pharmacies. Strengthen alliances with: Chest specialists, Infectologists, Generalists and internists as well as: Pharmacists, medicine schools and high concentration hospitals
Perspective cont n: Strengthen food supply support programs for patients - Provide transportation support for patients and family members - Provide holistic attention for people affected by TB with co-morbidities such as HIV/AIDS, diabetes and those with substance abuse (alcohol and drugs), and homelesses.
Perspective cont n: Development of TB research in the private system: Diagnostics kind Treatment schemes MDR TB schemes To apply the scale of default treatment risk in all TB patients including MDR and sensitives Strengthen promotors contracts for individualized care for high default treatment risk patiens.
Perspective cont n: To consolidate Elimination of catastrophic economic burden of TB for: Patients Government
Muchas gracias, Thank you very much, Muito obrigado. Detener la tuberculosis es compromiso de todos 2 CENAVECE http://cenave.gob.mx/tuberculosis