The most complete information regarding imaging modalities and the situation concerning installations and medical equipment belongs to the IMSS that shows that in the imaging equipment section, there are a total of 4,010 systems listed, where 30% are between 0 and 5 years of age, 30% have an age between 6 and 10 years, and 40% are more than 10 years old [2
]. According to IMSS criteria, an imaging system is considered to be obsolete when it is 10 years old, and 58% of X-ray equipment, 27% of ultrasound modalities, and 59% of CT scanners are over this age [2
Forty percent of the patients spend more than 8 h waiting in the emergency room because of a lack of imaging and laboratory equipment. This state of the infrastructure can be considered as the best of the public health care system, while all the other subsystems have an infrastructure that is below this standard.
With regard to the state of the imaging facilities when compared to other countries, we can see from Table that the number of large imaging modalities in Mexico is lagging behind many industrialized countries [1
]. According to the Organization for Economic Cooperation and Development (OECD) Health Data 2008, availability for MRI and CT imagers in the member nations is an average of one MRI scanner per 108,000 inhabitants and one CT per 52,000 persons. In Mexico, the numbers are one MRI per 714,000 inhabitants and one CT per 277,000 inhabitants (five times and 6.6 times less than the average, respectively) [3
]. Its infrastructure is similar to that of Iran [5
Number of MRI and CT systems per million inhabitants in different countries
An additional handicap is the fact that the traditional structure of health care in Mexico follows a pyramidal scheme—where at the basic level, clinics do not even have physicians for consultation. Only health care technicians are provided. At the second level, there are general hospitals, which provide basic hospital care, but high-level specialized medical attention exists only in third-level or regional hospitals. The problem with this structure is that all types of consultations have to proceed from the least sophisticated facility up to the regional hospitals through referrals. This includes situations like broken bones (first-level clinics do not have imaging equipment) and obstetrical/gynecological emergencies. Of course, the population often bypasses first-level clinics and thus emergency services at the higher levels are saturated. As a matter of policy, IMSS has planned to invest mostly on equipment for first-level clinics to improve the quality of health care.
The state of Guerrero is one of the three poorest states in the country and has 3 million inhabitants. Health care coverage is consequently lacking with respect to other richer states. Private infrastructure including hospitals with high technology exists in the city of Acapulco, but this is the sole city within the state with such characteristics and this type of care is not available to the majority of the population.
In 2002, for example, the population of the state without health coverage was 82% when compared to 60% in the whole country and 28% in the state of Nuevo León. In Guerrero, out of 3 million inhabitants, only 711,000 carry any type of insurance (23%) of the population. The total breakdown of those insured is 50% IMSS, 32% ISSSTE, and 13% Seguro Popular, which leaves 2.3 million inhabitants without coverage. [3
More recent data point to change. In 2005, the population of the state without health coverage was 62% when compared to 40% in the whole country and 23% in the state of Nuevo León. [6
] Unfortunately, these data are not as complete as in [3
], and further information on how the systems are distributed is not available.
From the point of view of high-technology diagnostic systems, the distribution is not homogeneous, for example, Table shows the number of different types of imaging equipment that is available for different regions in the country. The state of Aguascalientes is representative of the type of infrastructure available throughout the country. Mexico City has a fragmented distribution of resources, with the poorest regions having the least efficient coverage.
Number of inhabitants (thousands) per imaging modality
From these studies, a conclusion is drawn that there does not exist a common methodology in different states and subsectors to analyze the productivity, age, and state of repair of the different imaging systems. There is no policy for the distribution and priority assignment of imaging resources. There is no clear-cut method to determine when the systems are no longer financially viable.
As it can be seen, there is a need to generate strategies to minimize these inequalities. Some examples of solutions being tried is the creation of specialized medical units (UNEMES), which are oriented towards providing specific solutions to problems that are locally predominant. An example has been the installation of hemodialysis clinics where this coverage is not adequate. In this case, these specialized medical units are privately owned, but run jointly with public hospitals, where part of the private patient fees are devoted to defray the costs of the public health system patients.
With regard to imaging systems, this study undertook the analysis of the information available on the infrastructure in the state of Guerrero. According to this, the state public health infrastructure comprises, on one hand, 17 general hospitals with a total of 18 ultrasound systems, 28 X-ray machines, and a mammography unit and, on the other, 15 health care centers without ultrasound or mammography units but having 14 X-ray systems. There is only one CT system in the whole state, and it is installed in the Naval Hospital, which is unavailable to the general population. Table shows the entire imaging capacity of the public health system in Guerrero.
Imaging capacity in the public health services of the state of Guerrero (number of units)