MEXICO | Summary (2024)

OVERVIEW

HISTORY

In 1917, after the Mexican Revolution, the state of Mexico adopted a constitution with a deep social orientation towards the policies of education, work, and health. Due to reasons rooted in Mexico’s history, an effective health system was not adopted. The system has always been characterized by fragmentation and disparities in financial resources and the populations it serves. In 1943, the President established three prominent institutions that still govern and manage health care today. The Ministry of Health, the Mexican Social Security Institute (IMSS), and the Mexican Children’s Hospital. The Ministry of Health covers the populations who do not qualify for health insurance through the IMSS, which covers private-sector employees. The Children’s Hospital was the first of the 13 National Health Institutes now in existence in Mexico, which typically offers highly specialized services, seeks to increase knowledge through research, and has a high impact both nationally and internationally. Coverage was then expanded to public sector employees with the creation of the Institute of Security and Social Services for State Workers (ISSSTE) in 1960.⁷

To address rural health disparities, a program was put in place in the late 1930s. The President at the time opted to demand that all medical students spend a set of amount of time working and living among the poorest indigenous Mexicans. Although the program posed some challenges such as language barriers, introducing western medicine to the existing culture of medicine, and inadequate living conditions for students, it was written into the Mexican Constitution. This brought awareness to rural health concerns and made physicians more well-rounded by exposing them to medicine not included in their urban training.7 Another initiative to close the gap with rural areas was the COPLAMAR or the Program for Social Protection of Marginal Groups. It took a community-based approach to health services by training local people such as midwives and traditional healers to provide primary care to local communities. One aspect that was crucial to the success of the program was the belief that each patient’s culture, language, and beliefs about health and healing would be respected.⁸

In 1983, the Mexican Political Constitution was reformed to recognize health as a universal right requiring the government to coordinate the health system to ensure access to health to all citizens. It wasn’t until 2003 that the General Law of Health was amended to rollout the Popular Health Insurance, or Seguro Popular. Its intentions were to cover a broad sector of the Mexican population including the poorest in the country, those without formal employment, and not protected by the IMSS or the ISSSTE.⁷The Popular Health Insurance was Mexico’s approach to universal health coverage, however, out of pocket spending still remained high. In the span of 10 years after the Popular health Insurance was implemented, Mexicans who experienced impoverishing health care costs fell from 3.3% to 0.8% and extended coverage to more than 50 million who were previously unprotected. Past reports have shown high satisfaction rates in the high 90s from health service users with the Popular Health Insurance.⁹This health insurance program was replaced in January of 2020 with the Institute of Health for Welfare as a decentralized body of the Ministry of Health.

HEALTH & HEALTH SYSTEM

The second provider is the private sector with insurance companies and service providers that maintain their own clinics and hospitals. Private insurance is voluntary and individuals must pay premiums to the private insurer.¹⁴ Employers may offer private insurance to their employees where premiums and fees are split between the two. Premiums are determined by the individual’s risk profile and for a mutually agreed package of health services. The private health sector is better equipped to provides specialized procedures and overall higher quality care.¹⁶

Social programs through the government are the third major provider of health care and are reserved for citizens not covered by any other healthcare scheme. These programs are financed almost entirely by the federal government.¹⁴The prominent public health insurance scheme is the Institute of Health for Wellbeing (INSABI) which was established in January of 2020. Considering this is a new program, that replaced the prior public health insurance scheme, Seguro Popular”, there are still many components to finalize. Also, very little data exists to measure the effectiveness of the INSABI. The head of INSABI defends the program by affirming that the flaws and uncertainty are the products of the resistance faced by the ambitious project since it affects economic interests. He also mentions that the budget allocated to INSABI is much higher than the one allocated to Seguro Popular. The former Health Minister in charge of creating the now-extinct Seguro Popular, warns that a possible failure at the INSABI is because it puts the federal government in charge of medical attention, which was previously in the hands of local governments.¹⁷According to INSABI regulations,users will receive free medical care and medicines without restrictions since they will no longer need to enroll or pay fees. The annual fees associated with Seguro Popular have been eliminated as well as the requirement to be a Mexican citizen.¹⁸The requirements to receive care at the INSABI are currently very loose but legislation is subject to change due to the infancy of the program. Another program named IMSS-Opportunities is designed to cover specific vulnerable and marginalized populations and is funded completely by the federal government.

HEALTH INDICATORS & DEMOGRAPHICS