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Friday, July 22, 2011

Guest Blogger Eleanor D. Kinney: Greetings from Puerto Vallarta!!

Doc3  El 18 de Julio

 

 

There is a country south of the border – the United Mexican States – with a per capita GNP less than one-Ekinney third that of the United States (See Figure 1).  Yet that country, Mexico, has committed to universal health coverage for all its citizens as a matter of right.  With amendments of 2003, the Mexican constitution recognizes a constitutional right to health and health care.  Further, Mexico has adopted many of the international and regional human rights treaties that recognize an international human right to health (U. Minn).

 

 

The Mexican Constitution of 1917 (as amended to 2003) has two provisions regarding health and health care in its con­stitution. Constitución Política de los Estados Unidos Mexicanos [Constitution], as amended, Diario Oficial de la Federación [D.O], art. 4, 5 de Febrero de 1917 (Mex.).  One provision establishes a “right to health protec­tion” and sets forth what subordinate federal statutory law will authorize: 

Every person has the right to health protection. The law will describe the basis and means for access to health care services and will establish the concurrence of the Fed­eration and the federative entities in matters of public health. Boys and girls have the right to satisfy their nutrition, health, and education needs and for healthy recreation for their total development.

Figure 1

Relevant Statistical Indicators for the

United States, Canada and Mexico

 

Per capita GDP 2010*

Per Capita Health Expenditures, 2007**

 

$s

Rank

$s

% of GDP

Rank

Mexico

15,224

47th

823

5.9

29th

United States

47,084

6th

7,290

16.0

1st

Canada

39,699

10th

3,895

10.1

5th

Sources:  

*World Bank Group, 2010

**Organization for Economic Cooperation and Development, 2007

As discussed in my last blog entry, the Mexican Congress amended the Ley General de Salud to establish the System for the Social Protection in Health (SPSS) to establish the Seguros Popular for Mexico’s uninsured.  Ley General de Salud [The General Law of Health], as amended, art. 18, Diario Oficial de la Federación [D.O.], 7 de Febrero de 1984 (Mex).  The Seguros Popular initiative includes a universal health insurance scheme called the System for Social Protection in Health (SSPS). The health insurance scheme is financed jointly by the federal government, the states and higher income enrollees.

SSPS covers an essential package of personal health services for low risk, high probability illnesses and injuries. The services include ambulatory primary care and hospitalization for secondary care. The package of essential services is covered by funds at the state level. For the most part, services are provided through a network of providers who work for the state and federal public health sectors. The package of catastrophic interventions includes low-probability, high cost illnesses and injuries including cancers, cardiovascular disease, stroke, severe injuy and HIV-AIDS. Covered services include long-term rehabilitation, neo-natal intensive-care, organ transplantation, and dialysis. These tertiary care services are more limited and funded at the federal level.    (See F. Knaul and H. Arreola 2006).

With implementation starting in January 2004, the a seven year transition period during which SP will be offered on a progressive and voluntary basis to all Mexicans who are not already enrolled one of Mexico’s social insurance institutions. The aim was to have universal coverage in Mexico by 2012. There has been much progress in achieving this goal.  This progress and other aspects of the SSPS and SP are detailed on the website of the Comisión Nacional de Protección Social en Salud and the commission’s annual reports.  (See Comisión Nacional de Protección Social en Salud, Informe de Resultado del Segundo Semestre de 2009 (2009).

Before the Seguros Popular, more than 50 percent of Mexico’s population was uninsured (Knaul et. al., 2003).  Half of the Mexican population was at risk for catastrophic out of pocket medical costs and very limited access to health care services. The express purpose of Seguro Popular was to address this access problem for the poorest members of Mexican society. 

The big question for Seguros Popular generally and SSPS in particular is whether Mexico will be able to carry them off over the long term. The goal of extending coverage seems to be quite achievable. The real question will be if these coverage expansions can be absorbed by the Mexican health care sector and, in particular, the public provider network that serves the informal worker sector?  Also, can they be absorbed without unduly raising the cost of health care services in Mexico?  Finally, with the care provided under the initiative be of high quality? Fortunately, the Comisión Nacional de Protección Social en Salud is well aware of these issues and have been careful to evaluate coverage expansions and other aspects of the initiative.  

It is most interesting compare Mexico to its Northern neighbors, the United States and Canada. Clearly Mexico is more attuned to Canada with its guarantee of health coverage as a matter of right. Seemingly absent from the Mexican experience is the discussion of “government takeovers” of health care and concerns that government sponsored health bill bankrupt the country. One gets the sense that the Mexican government and the people of Mexico believe that health coverage for all people is important a country’s development and are willing to put universal coverage as a national priority.  

Hasta la Vista! 

 Eleanor D. Kinney

 

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