Publish in Perspectives - Tuesday, September 25, 2012
Mexico has made impressive progress in expanding health coverage and access to medicines, but there are still many Mexicans who need to be better served. (Photo: Mexican Health Ministry)
Despite an increase in health spending, Mexico still lags OECD and Latin America.
President-elect Enrique Peña Nieto campaigned on promises to improve Mexico's health system, which over the past decade has brought coverage to some 50 million citizens who had no health coverage before, according to recent studies. How successful have health reforms been in Mexico to date and what improvements still need to be made? What health reforms do you expect Peña Nieto to undertake and what forces stand in his way? What can other countries learn from Mexico's health reform experience?
Katherine E. Bliss, deputy director and senior fellow of the Global Health Policy Center and senior fellow of the Americas Program at the Center for Strategic and International Studies: Efforts to improve health conditions in Mexico date to the 1910 revolution, when officials created public health programs to serve vulnerable sectors and realize social and economic development goals. The system that evolved incorporates a fragmented collection of insurance schemes based on employment status and funded by government, employer and beneficiary contributions, although some wealthier citizens opt for private insurance. Recognizing that poor, uninsured citizens were spending up to 50 percent of their household budgets on health care, the administration of PAN President Vicente Fox in 2003 launched Seguro Popular to cover the self-employed, the unemployed and those working in the informal sector. The majority of Mexicans now count on health insurance, but challenges, including a paucity of facilities in remote areas and a lack of coverage for drugs to treat common health conditions, remain. During the 2012 elections, President-elect Enrique Peña Nieto of the PRI advocated greater coverage for necessary medicines and more doctors, nurses and hospital facilities in underserved regions. But generating the revenue to accomplish these changes may prove difficult. Mexico has increased its health spending to 6.4 percent of GDP, but this is still less than other OECD members, as well as many governments in the region. And in a period when national oil revenues, which support social sector spending in Mexico, are stagnant, increasing the health budget may be difficult. Countries seeking to implement universal health insurance may wish to consider the challenges presented by Mexico's fragmented, employment-based system and consider national plans to ensure equity and enhance access.
Nicolás Mariscal, member of the Advisor board and chairman of Grupo Marhnos in Mexico City: Mexico's public health system has achieved universal coverage due to reforms in this area and unprecedented efforts to improve the health care infrastructure. In the last six years, 1,200 hospitals, clinics or health centers have been constructed and another 2,500 have been remodeled. However, there is still much work to be done. The main challenge is to create a unique health system that allows for optimizing the capacity that Mexico has in this area in order to provide timely, efficient and quality services for the current and expected demand, especially considering that the coming decades will bring a significant aging of the population. Mexico also faces a major challenge in bringing these services to isolated communities that are found in various regions. President-elect Enrique Peña Nieto announced that he will create a health system that will complement these efforts with health insurance and a universal pension system. But to achieve this, it is necessary to reach agreements with the various labor unions involved in the Ministry of Health, Social Security and the Institute for Social Security and Services for State Workers, among others. Nevertheless, what has been achieved so far is a good base and the framework contains diverse aspects that can serve as a model for other countries, such as payment of a membership fee based on socioeconomic status.
Laura Schoen, chair for Latin America and president of the Global Health Care practice at Weber Shandwick: Although Mexico has done much to expand the right of its citizens to health services, there are still large disparities in quality and coverage. As Enrique Peña Nieto has stated, almost 36 million Mexicans continue to lack access to affordable and high-quality health care. The incoming administration hopes to work through Oportunidades, Mexico's highly successful conditional cash transfer program, to expand medical services to the poor, and to provide them with vouchers for buying medicines in pharmacies. The broader goal is to make these services universal for all Mexicans. Other countries, including the Unites States, have struggled with this complex challenge of offering care for all. Given continuing financial constraints, however, governments are often too ambitious in trying to cover all treatments instead of focusing on preventive care such as vaccination and diabetes screening. In any case, Mexico's current healthcare expenditure, at 6.9 percent of the GDP, remains low when compared with the Latin American average and won't be enough to cover the proposed reforms. Ultimately, the role of the government should be to lead the way to reform the healthcare system, but it will not succeed alone. Partnerships with the private sector to establish best practices, standard outcomes, and to eliminate waste are essential. The lessons learned in Mexico and around the world speak to the importance of balancing competing interests, including the private sector, to make healthcare affordable and to improve the quality of the services and access to medicines.