Rethinking Referral Systems in Rural Chiapas, a Mixed-Methods Study

Abstract

We conducted a mixed methods research study to understand complexities patients covered under Seguro Popular insurance face when referred for surgery in Chiapas, Mexico. We reviewed medical records to understand how many of the referred patients completed procedures. We also conducted interviews with patients and health care providers to explore the challenges and facilitators faced by individuals who must navigate this bureaucratic system to seek or provide health care. Quantitative findings indicate that if patients require a surgery, their odds of receiving it are greater if they go to Hospital Revolución, if they are males, and if they require an emergency surgery. The worst case scenario for patients is requiring an elective gynecological surgery. Qualitative findings suggest that barriers for patients to receive surgery dwell in the dimensions of conflict, while key facilitators rely on capital. Without economic or social capital patients are not able to receive a surgery.