Beyond health gain: the range of health system benefits expressed by social groups in Mexico and Central America

Current health reform proposals in most developing countries stress health gain as the chief evaluation criterion. Essential service packages are form ulated using cost-effectiveness methods for the selection of interventions without sufficient regard for other factors that are significant for succes sful implementation and acceptance by the needy. This paper presents the re sults of research undertaken in Mexico and Central America to test the hypo thesis: that population groups view health gain as only one among several b enefits derived from health systems. The goal at this stage was two-fold: ( a) to identify through qualitative methods the range of benefits that are s ignificant for a wide cross-section of social groups and (b) to classify su ch benefits in types amenable to be used in the development of instruments to measure the benefits intended and actually produced by health systems. F ourteen focus groups were undertaken in Costa Rice, Fl Salvador, Guatemala, Mexico and Nicaragua representing diverse age, gender, occupation and soci al conditions. Six major types of health system benefits were identified be sides health gain: reassurance/uncertainty reduction, economic security, co nfidence in health system quality, financial benefits derived from the syst em, health care process utility and health system fairness. Benefits most o ften mentioned can be classed under health care process utility and confide nce in system quality. They also have the most consensus across social grou ps. Other benefits mentioned have an affinity with social conditions. Human resource-derived utility stands out by its frequency in the range of benef its mentioned. Health systems and health sector reform proposals must empha sise those aspects of quality related to human resources to be in accord wi th population expectations. (C) 2001 Elsevier Science Ltd. All rights reser ved.