Older women’s access to and use of health-care services in Mexico

Abstract

In Mexico’s fragmented health-care system, the type of health insurance obtained depends predominantly on a person’s employer. Older women, a disadvantaged workforce compared to men, can face disadvantages in accessing health-care. The government, aiming for universalisation of healthcare services, introduced ‘Seguro Popular’ (SPS), an insurer and provider of health-care, in 2002-2003. The effect of SPS on older women’s health-care is not fully understood. This mixed-methods research aimed to understand the dynamics of older Mexican women’s access to and use of health-care services, to examine inequalities between subgroups of women (e.g. single, rural) and to study whether the variety of insurers provide sufficient access to health-care for older women. The first part of the study (secondary quantitative analysis) used the Mexican Health and Ageing Study (MHAS) as a dataset and the Andersen’s behavioural model as a conceptual framework. It found that older women’s entitlement to health-care insurance was largely derived from being a worker/pensioner’s dependent (through spouse or child(ren)). A 32% of women were affiliated to SPS and about 7% of the participants were unaffiliated to a health-care provider despite being eligible for SPS, while 15% had multiple affiliations. Moreover, women who were single (had never married) had significantly higher odds of being uninsured compared to married participants. The second part of the study (primary qualitative data collection) used thematic analysis to analyse 20 in-depth interviews with older women in Mexico. The results showed that spouses and children enabled the access and use of health-care services, while multiple affiliations were a way of maximising benefits. Participants preferred to receive financial and emotional support from their spouse rather than their child(ren). Some were reluctant to burden their children with expectations of support, while others viewed support from children as natural and reciprocal throughout the life course. Both sets of data lead to a conclusion that there are strong patterns of dependency on spouse and children in terms of access to health-care in later life. In order to provide accessible health-care services, better communication between insurers/providers and stronger presence in rural areas is recommended.

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ORCID for Rosalind Willis: orcid.org/0000-0001-6687-5799

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