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Biomedical subjects

J Frenk

Publications and source records attributed to J Frenk.

At least 55 records · Page 3Linked to original sources
PubMed1987

State intervention in medical care: types, trends and variables.

This article attempts to develop some of the basic elements for a theory of state intervention in medical care. First, a typology of state intervention is proposed based on two dimensions: the form of state control over the production of medical services and the basis for eligibility of the population. The resulting twelve types provide a means of describing national patterns of state intervention at a given point in time. Next, in order to analyse the changing patterns of state intervention in medical care over time, changes in state control and population coverage are used to construct three hypothetical 'paths' of state intervention, which may serve to depict broad historical trends in major groups of countries. In the final section, several variables are analysed according to their expected effect on the patterns of convergence and divergence in the form and degree of state intervention between countries. This cross-national comparative perspective is offered as a strategy for building a theory capable of explaining state intervention, a process that, to a large extent, informs the medical experience of today.

Eligibility Determination↗
PubMed1986

The health care reform in Mexico: before and after the 1985 earthquakes.

The earthquakes that hit Mexico City in September 1985 caused considerable damage both to the population and to important medical facilities. The disaster took place while the country was undertaking a profound reform of its health care system. This reform had introduced a new principle for allocating and distributing the benefits of health care, namely, the principle of citizenship. Operationally, the reform includes an effort to decentralize the decision-making authority, to modernize the administration, to achieve greater coordination within the health sector and among sectors, and to extend coverage to the entire population through an ambitious primary care program. This paper examines the health context in which the reform was taking place when the September earthquakes hit. After presenting the damages caused by the quakes, the paper analyzes the characteristics of the immediate response by the health system. Since many facilities within the system were severely damaged, a series of options for reconstruction are posited. The main lesson to be learned from the Mexican case is that cuts in health care programs are not the inevitable response to economic or natural crises. On the contrary, it is precisely when the majority of the population is undergoing difficulties that a universal and equitable health system becomes most necessary.

Delivery of Health Care↗
PubMed1986

An innovative approach to public health research: the case of a new center in Mexico.

This paper presents the conceptual and organizational elements that have guided the development of the Center for Public Health Research (CPHR) in Mexico. The CPHR was established in August 1984, in the midst of the most profound health care reform in Mexico in the last 40 years. The reform has included, among other measures, a Constitutional amendment recognizing the social right to health care, an energetic effort to decentralize the system so that each state will run its own services, an ambitious drive to extend primary health care coverage to all the population, and a strong promotion of research as the basis for strategic planning and for the development of standards of care. The creation of the CPHR is a response to the need for a firm base of epidemiologic and health systems research in Mexico. This need arises from the increasing complexity of the country's organizational arrangements for health care. In addition, the patterns of morbidity and mortality are also becoming more intricate, as Mexico is experiencing an epidemiologic transition whereby chronic diseases, mental ailments, and accidents are on the rise even as the incidence of infectious diseases and malnutrition continues to be high. As a unit of the Ministry of Health, the CPHR must strike a balance between relevance to decision making and excellence in the strict adherence to the norms of scientific research. To do so, it has developed a conceptual framework based on a tridimensional matrix. The dimensions of the matrix include substantive areas (i.e., the phenomena to be researched), knowledge areas (i.e., the disciplines pertinent to public health), and methodological areas (i.e., the methods to be applied in each project). The intersection of these dimensions produces different configurations of "research modules" that can be adapted to changing priorities. Current priorities of the CPHR include epidemiologic studies of the emerging conditions in the transition, migration and health, child survival, social organization and primary health care, health systems management, quality of care, and the development of information systems and quantitative models for public health research. Research projects are undertaken in a matrix type of organization in which academic departments are structured according to problems rather than disciplines. The analysis of Mexico's Center for Public Health Research may contribute to similar endeavors in other countries and also to the wider development of comparative studies on research organizations.

Mexico↗
PubMed1985

Career preferences under conditions of medical unemployment. The case of interns in Mexico.

This article presents a multivariate analysis of the career preferences of 923 Mexican interns. Such preferences were operationalized along two dimensions: type of activity (general/family practice, primary specialties, or subspecialties) and type of institution (public assistance, social security, or private). There were six independent variables: father's occupation, father's education, type of medical school, place of internship, assimilation to the internship hospital, and perception of the medical labor market. The appearance in recent years of unemployment and underemployment among Mexican physicians made labor market issues particularly salient. Thus the study offered an appropriate occasion to test the relative strengths of alternative explanations of career choice that are based on social mobility, professional socialization, or responses to labor market signals. Results obtained through multiple regression revealed that the most important variable in the determination of activity preference was medical school, although the two social origin variables retained the important role of directing students into different schools. With regard to institution preference, the most important factor was shown to be place of internship, as it interacted with the level of assimilation to the hospital. Although perception of the medical labor market was a significant predictor of both dimensions of career preference, the greater importance of the other variables indicated that, even under extreme conditions of medical unemployment, explanations of career choice must go beyond simple models of rational decisionmaking to include the experiences that socialize future physicians into dominant paradigms about medical practice.

Career Choice↗
PubMed1985

[Effects of social origins and professional socialization on the vocational preferences of medical interns in Mexico].

Using data from a survey of 923 medical interns in Mexico, this article analyzes preferences for type of medical activity (general or specialized practice), type of site (ambulatory or hospital), and type of medical care institution (public assistance, social security, or private). Four independent variables are examined: social origin, medical school, place of internship, and assimilation to the internship hospital. The great majority of the interns expressed a preference for specialty practice, hospitals, and social security institutions. The role of social origin was to selectively direct students into different medical schools. From then on, the structural attributes of the school itself and of the place of internship, as well as the socialization experiences that took place there, emerged as the most important determinants of career preferences. Such a process, however, tended to produce a "social specialization" of interns in terms of the role they expect to play in the medical field. It is argued that this kind of specialization has negative implications for the professional status of physicians, although it also poses a challenge to the development of innovative theories about the process of professionalization in medicine.

Career Choice↗
PubMed1984

[Medical care, medical education, and the job market for physicians: internship in Mexico].

This article endeavors to establish a connection between the emergence and development of internship in Mexico and a series of macrosocial changes, including the extension of Government intervention in medical care, the labor market processes that have led to unemployment among physicians, and the responses of the medical education system. The author considers that this comprehensive analysis will be of use in understanding at least in part the complex dynamics of the influence exerted on each other by medical care and medical education, and particularly how changes in conditions on the labor market for physicians have led to the formulation of ideological paradigms of medical practice and to their institutionalization in the programs of study of the medical schools. The study is also important for developed and developing countries with increasing numbers of physicians and which therefore need to understand the possible causes and effects of this trend.

Developing Countries↗
PubMed1983

Career preferences and perceptions of the medical labor market among Mexican interns.

This paper examines the relationship between choice of career and perception of the medical labor market, as well as the effects of social origin, type of medical school, and place of internship. The data are derived from a survey of interns which was conducted in Mexico during 1978, when a substantial proportion of physicians was unemployed or underemployed. Career preferences were operationalized in terms of type of activity (general practice or specialty), site (ambulatory or hospital) and institution (public assistance, social security or private). Perceptions of the medical labor market were measured as an 'objective' feasibility perception and a 'subjective' opportunity assessment. Additionally, composite indices of career preferences and perceptions were constructed in order to take account of two integrated career patterns: dominant (or majority preference) vs alternative (or minority preference). Analysis of the data consistently revealed that perception of the medical labor market had a much stronger impact on preference for alternative than for dominant career patterns. Whereas social origin had no effect on career preference, type of medical school and place of internship exhibited a statistical interaction with career preference, suggesting that certain structural conditions of the medical school and the teaching hospitals led to preference for alternative rather than dominant careers. The implications of the findings are discussed with regard to health manpower policy, to conceptions of rational career choice and to the professional status of medicine in Mexico.

Analysis of Variance↗
PubMedDate not supplied

Comprehensive policy analysis for health system reform.

This article presents the results of a comprehensive approach to policy analysis that may serve as an input for health system reform. The comprehensive character of this effort stems from the attempt to combine, in a coherent framework, various analytical tools that have been developed recently, such as measurement of the burden of disease, cost-effectiveness analysis to integrate packages of essential interventions, national health accounts, assessment of system performance, consumer surveys, and political mapping. These tools were all applied in a study that was carried out in Mexico from August 1993 through September 1994. After explaining the logic of the study, the paper summarizes the findings and recommendations under five headings that shape the form of reform: the problems, the principles, the purposes, the proposals, and the protagonists. Rather than describing these various elements in detail, the paper focuses on the strategic aspects, which are most relevant to other countries currently planning or implementing reform initiatives. The article concludes that, under the current wave of international interest in health system reform, it is necessary to establish a mechanism for shared learning at the global level. Only in this way will it be possible to reproduce the analytical skills and accumulate the body of evidence that health systems require for their sustained improvement.

Delivery of Health Care↗