National Health Reform in Mexico

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seguro_popular

Photo credit: The Yucatan Times via google

 

In 2003, Mexico legalized a health reform policy that endorsed the introduction a health insurance mechanism called Seguro Popular de Salud (SPS).   SPS was designed to secure universal health coverage (UHC) for all citizens.

Dr. Julio Frenk, who was then the secretary of the health, led the team of reformers who drew upon years of accrued evidence to build support at the federal level through successful lobbying efforts and by sidelining opponents in the executive and legislature.  Their efforts proved successful at ensuring the program’s adoption into policy.

However, one issue of fragmentation in health services provision was not adequately addressed. Prior to the policy’s adoption, formal workers received services through either the Social Security Institute (IMSS) or the Institute for Social Security and Services for Civil Servants (ISSSTE).  Informal workers received health services under public assistance or from the private sector, with no financial protections. 

Frenk and his team pushed for a nationally integrated insurance scheme through the  Family Health Insurance Scheme (FHI) run by the IMSS that would be independent from a competitive market for services provision.  Threatened by Frenk’s competitive model , the IMSS and Ministry of Health providers resisted. So, rather than becoming a national insurance scheme, SPS was left to function as a subsidy service for the poor.

SPS has recorded notable successes in increasing coverage for mostly informal workers and for the poor. However, the program can ensure greater coverage and financial protection through risk sharing across the entire Mexican population. Additionally, the introduction of consumer choice through competition will ensure greater efficiency in service provision. To achieve these, the federal government must secure buy-in from the IMSS and MOH unions  to pass a nationally integrated insurance scheme that ensures a maximal pool and adequate competition among providers.

 

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4 Responses to “National Health Reform in Mexico”

  1. ajosyulamd Says:

    My blog post was also on health care reform, so your post caught my eye. I think it’s fantastic that, though a single payer system wasn’t achieved, a large segment of the population was able to get health insurance. I wonder if it would be too challenging for a single payer to meet the needs of a socioeconomically diverse population and perhaps the current system is the best outcome. I would also be curious to know what sort of advocacy groups exist to help support and spread awareness, among both the policy makers and the public regarding a single payer system. Perhaps, those governmental departments who were resistant to moving to a single payer system, would be more responsive if the public expressed their support for it.

  2. tamiloreareola Says:

    Hi ajosyulamd. You’re asking very key questions. My understanding was that the public was largely excluded from what was a highly political conversation. This might be owing to the esoteric language of reform proponents who were all technocrats. As for your first question, no I don’t believe a single payer system would have adverse effects on a diverse population. Integration would simply strengthen the pool. Besides, Frenk and his colleagues advocated for separating the payer and provider. This means a stronger financial pool but with diversity in service provision to allow for the kind of competition that ensures adequate attention to the needs of diverse consumers. This would be particularly helpful for the poor, who do not enjoy the kind of institutional protection enjoyed by those covered under the IMSS and ISSSTE. Competition would force providers to cater adequately to every consumer, particularly where there is financial protection for all.

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