When health systems are barriers to health care: challenges faced by uninsured Mexican kidney patients.

Kierans, Ciara ORCID: 0000-0001-7268-4438, Padilla-Altamira, Cesar ORCID: 0000-0003-2926-2592, Garcia-Garcia, Guillermo ORCID: 0000-0003-0558-0035, Ibarra-Hernandez, Margarita and Mercado, Francisco J (2013) When health systems are barriers to health care: challenges faced by uninsured Mexican kidney patients. PloS one, 8 (1). e54380-.

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Abstract

<h4>Background</h4>Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT.<h4>Methods</h4>The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings.<h4>Results</h4>In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information.<h4>Conclusions</h4>Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an important source of evidence in that effort.

Item Type:	Article
Additional Information:	## TULIP Type: Articles/Papers (Journal) ##
Uncontrolled Keywords:	Humans, Kidney Diseases, Kidney Transplantation, Health Care Reform, Poverty, Adolescent, Medically Uninsured, Cost-Benefit Analysis, Health Services Needs and Demand, Community Health Planning, Delivery of Health Care, Mexico, Female, Male, Young Adult
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health
Depositing User:	Symplectic Admin
Date Deposited:	25 Mar 2024 08:30
Last Modified:	25 Mar 2024 08:30
DOI:	10.1371/journal.pone.0054380
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3179853