“Seguro Popular” has improved healthcare in Mexico providing health coverage to millions of Mexicans. Since 2003/2004 noteworthy achievements have been reached. Unfortunately, many challenges are still at stage. The healthcare system is still too fragmented forcing individuals to face unbelievable out of pocket payments. Since the last June the Government has implemented a new regulation aiming at promoting further cooperation between the various Mexican healthcare service providers. Will this be sufficient to improve access to services and their quality?
Since the introduction of “Seguro Popular” in 2004, a system of public and voluntary insurance by the Government of Mexico, aimed to expand coverage of health services for low-income populations who are employed or are self-employed, and are not beneficiaries of any social institution, the Mexican healthcare system has made significant progress in insurance coverage. Since 2004, some 56 million people at risk of catastrophic expenditure on health now have access to health insurance and 93 out of 100 Mexicans have some kind of health coverage. Additionally, key parameters such as infant mortality and maternal mortality have improved. Furthermore, according to an OECD report, from 2003 to 2013 public investment in Mexico’s health system has risen from 2.4% to 3.2% GDP; in 2014, health expenditure was 6.3% of the GDP. Yet, doubts remain about how this money is invested and translated into health gains. Some indicators, such as Out of Pocket Payments (OOPs) or data about the quality of health services, suggest that the system is not working as efficiently as it could. For instance, about 45% of spending on healthcare and medicine is still OOP by patients and their families, often resulting in dire financial consequences.
Some fundamental reasons behind inefficiencies of the scheme have been attributed to the structure of the Mexican health system, which based on several disconnected sub-systems that provide different levels of care, at different prices and with different outcomes, thus producing marked inequalities in access and quality and reflecting socio-economic disadvantages.
This fragmentation is detectable in the health information infrastructure too. Finally, Mexico has started to build a national health information infrastructure for quality monitoring and the “Sistema Nacional de Indicadores de Calidad en Salud” (INDICAS) has published several indicators over the past decade. Additionally, a number of other initiatives are underway in the separate sub-systems. Despite an effort to collect data, their systematic use to improve care appears rare. Directly related to the weak information infrastructure, information about healthcare quality is relatively limited. In 2015, Mexico was able to report on only 8 out of the 52 indicators requested by OECD and their analysis gives cause for concern showing a low quality level of the services provided in the public system. Due to this, individuals quite often rely on the private system. In fact, more than 90% of Mexicans have some coverage in the public system, but millions of insured shun public hospitals and opt for private health, with subsequent purchase of medicine in private pharmacies, fueling exorbitant private spending.
Inequities are also reflected in the access to health among indigenous people, especially those speaking indigenous languages. A 2012 Health Secretariat report revealed that there are 485 municipalities in Mexico in which at least seven of 10 inhabitants speak an indigenous language. In those 485 municipalities, there are fewer doctors, fewer nurses, fewer health facilities, fewer hospital beds, fewer specialists and less medical testing equipment than in the rest of the municipalities. Besides the lack of personnel and supplies, in indigenous municipalities there are 10 times more medical interns in charge of health clinics than in other municipalities across the country. This also implies, that the poorest communities don’t just lack medicine and medical equipment they are also assigned often very inexperienced healthcare providers.
Despite these issues, an effort is being made to improve the system. A few months ago, on the 7th of April, the President Peña Nieto signed the National Agreement about the creation of universal coverage of health services. The plan aims at gradually achieving health coverage for the whole population and at obtaining increased coordination among the federal institutions, the social security agencies and the healthcare service providers. As such, since last June, a patient can be treated in hospitals of the “Instituto Mexicano del Seguro Social (IMSS)”, of the “Instituto de Seguridad y Sevicios Sociales de los Trabajadores del Estado (ISSSTE)” and of the Federal and states health secretaries. This was not possible before.
Additionally, last month, the Mexican government signed two agreements with Canada and Germany towards improving the health sector. Both agreements aimed at facilitating the exchange of information on the regulation of therapeutic, pharmaceutical, biological products and medical devices and herbal products, cosmetics, controlled drugs and environmental health. In addition, the Governments will work together on areas such as quality of care, patient safety, health regulation and best medical practices, which will help to raise the level of care provided to the population.
Definitely, these are small steps; despite noteworthy achievements in expanding health insurance coverage to most of its citizens, with the introduction of the “Seguro Popular”, the Mexican healthcare system continues to face challenges to ensure that citizens have access to needed health services that is timely and of a reasonable quality. While the government is clearly dedicated in its efforts to improve access to healthcare for its people, accelerating efforts would enable many more to benefit from these efforts.