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.