Health Reform Lessons from Mexico

Editor’s note: This post is part of a three-week series examining innovation in health care, published in partnership with the Advanced Leadership Initiative at Harvard University. Health systems are at a crossroads. Throughout the world, countries at all levels of economic development and with all types of political systems have embarked in a creative search for the elusive goal of universal coverage. From Chile, China, and Ghana to the USA, India, and Rwanda, novel ways to confront the health challenges of the 21st century are being designed and put to the test. Mexico had an early start in the current generation of health reform initiatives. A major effort launched in 2003 will provide health insurance to everyone before the end of this year. A bloody war against drug cartels is going on south of the border, but so are interesting social experiments. These experiments are starting to occupy the headlines of major newspapers and to attract the attention of development agencies and health policy experts worldwide. Studies carried out by several academic institutions and think tanks revealed that every year more than four million Mexican households were falling victims of catastrophic expenditures due to health care payments. The reason: half of the population lacked health insurance. These households were being forced to use their lifetime savings, sell their most treasured belongings, or borrow heavily to meet their health needs. This analysis brought to light an unacceptable paradox: We know that health care is one of the most effective ways of fighting poverty, yet medical care can itself become an impoverishing factor for families when a country does not have the social mechanisms to protect the population against financial shocks derived from the universally human reality of falling sick. The evidence generated by these studies was used by the Ministry of Health to promote a major legislative reform establishing a new system of social protection in health, which was approved by a large majority of the Mexican Congress in 2003. This system has reorganized and increased public funding by a full percentage point of GDP in order to provide universal health insurance, including the 50 million Mexicans, most of them poor, who had been excluded from formal social insurance schemes. As in the US, health insurance in Mexico had been dependent on employment and limited to salaried employees in private firms or in public-sector institutions, as well as to their families. Previously uninsured families can now enroll in a new public scheme called Seguro Popular, which guarantees access to over 250 medical interventions and the respective drugs. These interventions include all services provided in ambulatory clinics and general hospitals. Seguro Popular also covers a package of 18 expensive interventions, including treatment for cancer in children, HIV/AIDS, and cervical and breast cancer. It is worth mentioning that the new law mandated that poorest families would be enrolled first, thus exemplifying what Davidson Gwatkin, from the Development Institute in Washington, has called “progressive universalism,” which expands coverage first among disadvantaged groups. Seguro Popular has elicited an enthusiastic response from the population. By December of 2010, 40 million people were enrolled in it, and the country is on track to achieving the goal of universal coverage this year. A story of how this is taking place was recently published in the New York Times: “Mexico’s universal health care is work in progress”. The potential impacts of Seguro Popular are enormous and some of them have already been documented through a rigorous external evaluation designed and implemented by researchers from Harvard University and the National Institute of Public Health of Mexico. As mentioned before, regular access to health care through social protection schemes directly contributes to the fight against poverty, and it does so not only by avoiding the direct disbursement of large sums of out-of-pocket money, but also by preventing debts and the sale of family assets, especially those that have a productive use, the loss of which reduces future household income. Furthermore, social protection mechanisms for health liberate resources which families previously tended to invest in health care. These resources can now be used to meet other basic needs, such as nutrition and education. Finally, a properly working social protection system contributes to health gains, and as recent economic research has demonstrated, good health improves educational performance, increases labor productivity, enhances the investment climate and, by doing all these things, stimulates economic growth, which, in a virtuous circle, in turn improves population health. So take a look at the social policies recently developed in Mexico. They are fighting a different war, against ill health and poverty, and the prospects are very promising. Julio Frenk is Dean of the Harvard School of Public Health and was Minister of Health of Mexico from 2000 to 2006. Learn more about the Advanced Leadership Initiative.

Health Reform Lessons from Mexico

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