Labour precariousness in the Mexican health workforce: taking to the surface a neglected problematic issue.

Abstract

Background: Little attention has been paid to quantifying job precariousness among health workers in low- and middle-income countries. Analytical models of human resources for health omit work precarity as a relevant phenomenon. However, analysing job precariousness is critical to improving health systems' performance.

Methods: We analysed pooled cross-sectional population-based data from Mexico's National Occupation and Employment Survey for 31,394 physicians and nurses between 2005 and 2022, representing almost 7, 8 million nationally throughout the study period. We used a pooled state and year fixed-effects multiple logistic regression to estimate the likelihood of having precarious employment for each survey year in both groups and according to the private/public employment sector. We conducted post hoc comparisons of quintiles of changes (2005-2022) in the adjusted percentage of labour precariousness according to the employment sector and of the private-public labour precariousness gap by state.

Findings: There was sustained growth in labour precariousness (from 58.7 and 49.0% in 2005 to 75.5% and 67.3% in 2022 among physicians and nurses, respectively). In both groups of professionals, labour precariousness was steadily higher in the private sector. However, the private-public gap narrowed to a greater extent and more accelerated among physicians than among nurses. The reduction in the private-public precariousness gap was not territorially random either (range - 39.5% to - 46.9%), with higher levels of convergence between both labour sectors, especially in the poorest socioeconomic regions.

Conclusions: The differences in the nursing and medical labour market composition have exposed the latter to the growth of precariousness due to their historical link with the private sector. The closing of the gap between public and private is a result of the recent expansion of precarious work in the latter. It is essential to develop regulatory policies to reduce precariousness and its effects on the health system applicable to both sectors.