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Pobreza y marginalidad como criterio de priorización para las enfermedades catastróficas en México

Introduction In one of the stages of the research entitled Model for evaluation of sustainability of the Protection Fund against Catastrophic Expenditures in Mexico, 2005-2010, a process of prioritization of 30 catastrophic diseases taken from the Mexican General Health Council Official List was developed. This process was based on four criteria: significance, social loss, marginality and institutional response capacities. This paper described those aspects related to marginality. Objectives To describe the calculation and application of the marginality criterion within the prioritization process and to show the final results. Methods The methodology involved the use of the Human Development Index for each of the 32 Mexican federative entities and the estimation of the correlation index between the Human Development Index and the mortality rates of the 30 catastrophic diseases in the year 2004. Results The results showed a moderate correlation between the federative entities with lower socioeconomic development and higher rates of catastrophic diseases, particularly for cervix and uterine cancer, a disease that is not eligible for financing by the Protection Fund. The process of prioritization as a contribution to the System of Social Protection in Health in Mexico and also calculation of the marginality criterion for the detection of territorial inequalities were both considered novelties. Conclusions The importance of re-directing the health reform models to socially-focused strategies that benefit marginalized or impoverished populations and of devoting some resources to those less favoured entities was recognized