Although the country is moving in the right direction with regards to universal coverage, a number of barriers to effective implementation remain.
57.3 million previously uninsured Mexicans are now enrolled in Seguro Popular
Gabriel O’Shea, Seguro Popular
Healthcare is one of the next items on President Peña Nieto’s busy agenda. The objective: moving Mexico towards universal healthcare coverage. The initiative was started at the beginning of 2000 by the previous government with the objective of ensuring in the long term that “any Mexican – employed or unemployed – could go anywhere in the country and get quality healthcare at any institution,” explains Maki Ortiz, president of the Health Commission at the Senate.
Historically, the Mexican health system has been fragmented among different providers and access to healthcare services was only offered to salaried workers and their families. At the beginning of 2000, the two main public healthcare providers – the Mexican Institute for Social Security (IMSS) and the Institute for Social Security and Services for Civil Servants (ISSSTE) – hardly covered half of the population, leaving nearly 50 million Mexicans uninsured. Since then, Mexico has gone a long way towards the creation of a universal healthcare system. The first important milestone was laid in 2004 with the launch of Seguro Popular, a public insurance scheme offering previously uncovered Mexicans access to a package of basic health services. A decade after its implementation, national commissioner Gabriel O’Shea announced proudly that: “57.3 million previously uninsured Mexicans are now enrolled in Seguro Popular.”
“When Seguro Popular was approved a decade ago, we were aware that this was a mid-term reform and that the next step was the integration of the public institutions providing healthcare services in Mexico and the possibility of interaction with private care providers,” comments Julio Frenk, former minister of health and currently dean at the Harvard TH Chan School of Public Health. After universal enrollment – today almost completed – the next step is universal coverage, which means access to a package of comprehensive healthcare services with financial protection. Over the last ten years, the number of interventions covered by Seguro Popular has increased threefold, the amount of drugs included more than 300 percent, and the number of diseases included in the so-called fund for protection against catastrophic expenditures raised from four to 59. The last step would be universal effective coverage, which implies services are provided with a level of quality that ensures a successful effect on the patient as well as on society. As Enrique Ruelas, former president of the National Academy of Medicine, points out, “universal health coverage is about value, not only volume. If you don’t introduce quality into the equation, you risk doing more harm than good.”
The upcoming reform aims to create a universal healthcare system under the concepts of portability of services and convergence. The idea is to give Mexicans the opportunity to use healthcare services at any institution, independent of their affiliation – a measure already approved for obstetric emergencies to face the dramatic number of maternal deaths in the country. This will soon include a limited number of chronic-degenerative diseases, such as heart failure, diabetes, kidney transplants and HIV, among others, before moving on to cover more diseases over time. “Three main institutions cover more than 90 percent of our population: if we let people choose among those three options through universal healthcare coverage, this will lead to a healthy competition to see who can provide the best service. I see that as something extremely positive that can take our health care system to a whole new level,” comments Guillermo Soberón, former minister of health.
However, a number of challenges stand in the way of the effective implementation of universal coverage. First, universal enrollment: while the Ministry of Health claims that full coverage has almost been reached, Hector Valle, former general manager for Northern Latin America at IMS Health, argues that “studies carried out by IMS Health, the National Public Health Institute and the National Institute for Statistics and Geography (Inegi) indicate that around 20 percent of the population is still uncovered.” Second, healthcare expenditure. Over the last decade, despite the number of Mexicans enrolled skyrocketing, total expenditure on healthcare increased from 6 percent to just 6.2 percent, well below the average 7.4 percent of other Latin American countries and the 9.3 percent average of OECD countries; on top of this, nearly half is still paid directly by patients. Additionally, the Ministry of Health recently announced a cut of nearly USD 650 million to the health budget, probably a consequence of the steep fall in oil prices. A further hindrance is effective integration of different healthcare providers. “The systems and processes they are using today are completely different and separate. If you want to build an integrated system, you first have to standardize and connect the existing ones – something which is not happening yet,” points out Valle. Last but not least, as José Campillo, president of the Mexican Health Foundation (Funsalud) argues, “we support increased participation of the private sector in the health sector through outsourcing of services and public-private partnerships. But there are still many questions about how this should happen.”
Roberto Tapia, CEO of the Carlos Slim Foundation, shares the same worries. “How can you imagine an integrated health system without having a shared information system among the different institutions? How can you think of having an accountable health system if the different institutions are not connected?” For this reason the foundation gave itself the mission to help the healthcare system include more innovation. Two examples are the initiatives Amanece and Casalud, aimed at respectively reducing maternal and infant mortality and ‘reengineering’ healthcare services at primary care units. “We are going slowly but firmly believe it’s the right time to push for concrete changes,” he says.
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