OBJECTIVE:To analyze the challenges facing the Mexican healthcare system from a theory of change perspective and propose a feasible path to achieving effective, high-quality access. METHOD:A theory of change for the Mexican healthcare system was developed based on a narrative review that identified the desirable characteristics and mechanisms of action that lead to effective, quality access. A documentary review of the reforms to the General Health Law between 1984 and 2024 identified the potential contribution of the modifications to the system toward achieving the proposed theory of change. RESULTS:The theory of change of the Mexican health system allows us to identify the path toward effective and quality access, while also highlighting areas in which progress has not been made due to the absence of interventions. Although the various reforms analyzed have generated changes in the design of the system, they have not succeeded in consolidating a design consistent with effective and quality access. CONCLUSIONS:The Mexican health system requires a redesign that provides effective and quality access for the entire population, that is, an integrated system that does not segment by employment status or ability to pay. A system that includes the elements and mechanisms identified with the theory of change would make it possible to guarantee effective and quality access for the entire population.
Objetivo Analizar, desde una perspectiva de la teoría de cambio, los retos que enfrenta el sistema de salud mexicano y proponer una ruta factible para el logro del acceso efectivo y con calidad. Método Se desarrolló una teoría del cambio del sistema de salud mexicano a partir de una revisión narrativa en la que se identificaron las características y los mecanismos de acción deseables que podrían conducir al acceso efectivo con calidad. Mediante una revisión documental de las reformas a la Ley General de Salud entre 1984 y 2024 se identificó el aporte potencial de las modificaciones al sistema para el logro de la teoría del cambio propuesta. Resultados La teoría del cambio del sistema de salud mexicano permite identificar la ruta hacia el acceso efectivo y con calidad, a la vez que visibiliza las áreas en las cuales no se ha logrado avanzar debido a la ausencia de intervenciones. Si bien las diferentes reformas analizadas han generado cambios en el diseño del sistema, no han logrado consolidar un diseño coherente con el acceso efectivo y de calidad. Conclusiones El sistema de salud mexicano requiere un rediseño que plantee el acceso efectivo y de calidad para toda la población, es decir, un sistema integrado que no segmente por condición laboral ni capacidad de pago. Un sistema que comprenda los elementos y mecanismos identificados con la teoría del cambio permitiría garantizar el acceso efectivo y con calidad a toda la población.
OBJECTIVE:To estimate the lifetime prevalence ratios of experiences of sexual violence and analyze the sociodemographic factors associated with this type of violence in young adults. METHOD:Data were drawn from the 2022 Chilean National Survey of Health, Sexuality, and Gender. Analysis included 1003 young adults aged 18-19 years. Lifetime prevalence of sexual harassment and violence included experiences ranging from verbal harassment and inappropriate comments to forced sexual contact. Prevalence was estimated by sex, and associated factors were analyzed using robust Poisson regression models to estimate crude and adjusted prevalence ratios. RESULTS:Overall, 59.0% (95% CI: 55.9-62.0) reported at least one lifetime experience of sexual violence, with prevalence estimates of 52.0% (95% CI: 46.5-57.5) among men and 62.3% (95% CI: 58.6-65.8) among women. Prevalence was higher among women (aPR: 1.21; 95% CI: 1.07-1.35) and non-heterosexual participants (aPR: 1.49; 95% CI: 1.35-1.63) compared with their reference groups. CONCLUSIONS:This study demonstrates that experiences of sexual violence have an high prevalence among young adults. The differential associations due to sex assigned at birth and sexual orientation constitute a key basis for the development of interventions aimed at promoting safe youth development and a transition to adulthood with the least possible burden on mental and physical health.
