Scaling up cancer care for children without medical insurance in developing countries: The case of Mexico |
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| Authors: | Ricardo Pérez‐Cuevas MD Msc DrSc Svetlana V Doubova MD Msc DrSc Marta Zapata‐Tarres MD Msc Sergio Flores‐Hernández MD Msc Lindsay Frazier MD ScM Carlos Rodríguez‐Galindo MD Gabriel Cortes‐Gallo MD Salomon Chertorivski‐Woldenberg MPP Onofre Muñoz‐Hernández MD Msc |
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| Institution: | 1. Division of Social Protection and Health, Inter American Development Bank, Mexico City, Mexico;2. Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico;3. Oncology Department, Hospital Infantil de México Federico Gomez, Mexico City, Mexico;4. Center of Research on Population Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico;5. Harvard Medical School and Dana‐Farber Cancer Institute, Boston, Massachusetts;6. Medical Insurance for the New Generation Program, Mexico City, Mexico;7. Ministry of Health, Mexico City, Mexico;8. Research Division, Hospital Infantil de México Federico Gómez, Mexico City, Mexico |
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| Abstract: | Background In 2006, the Mexican government launched the Fund for Protection Against Catastrophic Expenditures (FPGC) to support financially healthcare of high cost illnesses. This study aimed at answering the question whether FPGC improved coverage for cancer care and to measure survival of FPGC affiliated children with cancer. Procedure A retrospective cohort study (2006–2009) was conducted in 47 public hospitals. Information of children and adolescents with cancer was analyzed. The coverage was estimated in accordance with expected number of incident cases and those registered at FPGC. The survival was analyzed by using Kaplan–Meier survival curves and Cox proportional hazards regression modeling. Results The study included 3,821 patients. From 2006 to 2009, coverage of new cancer cases increased from 3.3% to 55.3%. Principal diagnoses were acute lymphoblastic leukemia (ALL, 46.4%), central nervous system (CNS) tumors (8.2%), and acute myeloid leukemia (AML, 7.4%). The survival rates at 36 months were ALL (50%), AML (30.5%), Hodgkin lymphoma (74.5%), Non‐Hodgkin lymphoma (40.1%), CNS tumors (32.8%), renal tumors (58.4%), bone tumors (33.4%), retinoblastoma (59.2%), and other solid tumors (52.6%). The 3‐year overall survival rates varied among the regions; children between the east and south‐southeast had the higher risks (hazard ratio 3.0; 95% CI: 2.3–3.9) and 2.4; 95% CI: 2.0–2.8) of death from disease when compared with those from the central region. Conclusion FPGC has increased coverage of cancer cases. Survival rates were different throughout the country. It is necessary to evaluate the effectiveness of this policy to increase access and identify opportunities to reduce the differences in survival. Pediatr Blood Cancer 2013;60:196–203. © 2012 Wiley Periodicals, Inc. |
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| Keywords: | childhood cancer developing countries survival experience |
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